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Yousef Khan F. Enterococcal meningitis/ventriculitis in Qatar-Experience with eight patients. Qatar Med J 2021; 2020:46. [PMID: 33598416 PMCID: PMC7856912 DOI: 10.5339/qmj.2020.46] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2020] [Accepted: 11/02/2020] [Indexed: 11/16/2022] Open
Abstract
Background & objectives: Enterococcal meningitis/ventriculitis (EMV) is a relatively rare condition that usually affects patients with underlying diseases. This study was designed to describe the clinical profile, laboratory parameters, treatment, and outcomes of EMV in patients admitted to Hamad General Hospital, Qatar. Methods and material: This retrospective hospital-based study described the patients with EMV from 2009 to 2013. Results: Eight patients were recruited for the study. Their median age was 42 years (21.50–53.75 years). Six patients (75%) were males, and two (25%) were females. Fever was the most common presenting symptom being present in seven (87.5%) cases. Six patients (75%) had nosocomial EMV, and all acquired the infection after placement of an external ventricular drain (EVD). The isolated species include seven (87.5%) E. faecalis and one (12.5%) E. gallinarum, and all of them were sensitive to ampicillin and vancomycin. In all patients with nosocomial EMV, the infected EVDs were removed, and the eight patients received empirical antibiotics that were modified upon receipt of culture results. All patients were cured, and no mortality was reported. Conclusions: EMV is a recognized complication related to the introduction of EVD, whereas community-acquired enterococcal meningitis was reported among children who had no established risk factors or immunosuppression. Because of its nonspecific clinical presentation, treating physicians should have a high suspicion index.
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Affiliation(s)
- Fahmi Yousef Khan
- Department of Medicine, Hamad General Hospital, P.O. Box 3050, Doha, Qatar E-mail:
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2
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Bhalla G, Rajwadkar V, Grover N, Sarao M. Nosocomial recurrent bacterial meningitis/ventriculitis postelective surgery in a case of total knee replacement. JOURNAL OF MARINE MEDICAL SOCIETY 2021. [DOI: 10.4103/jmms.jmms_73_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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3
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Sowole L, Ming DK, Davies F. Multidrug-resistant bacteria. Br J Hosp Med (Lond) 2019; 79:C66-C69. [PMID: 29727225 DOI: 10.12968/hmed.2018.79.5.c66] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Luciana Sowole
- Speciality Trainee in Infectious Diseases and Microbiology, Department of Microbiology, Imperial College Healthcare NHS Trust, London W6 8RF
| | - Damien K Ming
- Academic Clinical Fellow in Infectious Diseases and General Internal Medicine, Department of Microbiology, Charing Cross Hospital, Imperial College Healthcare NHS Trust, London
| | - Frances Davies
- Consultant Microbiologist, Department of Microbiology, Charing Cross Hospital, Imperial College Healthcare NHS Trust, London
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4
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Khanum I, Anwar S, Farooque A. Enterococcal Meningitis/Ventriculitis: A Tertiary Care Experience. Asian J Neurosurg 2019; 14:102-105. [PMID: 30937018 PMCID: PMC6417351 DOI: 10.4103/ajns.ajns_260_17] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Context: Enterococcal meningitis is very rare among bacterial meningitis and has variable clinical outcomes. Aims: The purpose of the current study is to evaluate clinical features, therapeutic options with susceptibility profile, and outcomes of enterococcal meningitis in a tertiary care hospital. Settings and Design: We retrospectively reviewed medical records of all patients with enterococcal meningitis over the periods of 4 years. Subjects and Methods: The clinical and laboratory data of all patients with enterococcal meningitis were evaluated between 2013 and 2016. Results: Six cases of enterococcal meningitis were found (three infant and three adults). All patients developed meningitis after neurosurgical procedures, and majority of patients (four out of six) had central nervous system (CNS) devices in situ at the time of development of meningitis. The causative organism isolated from cerebrospinal fluid (CSF) culture of all patients was Enterococcus species only. All Enterococcus spp. were resistant to ampicillin, Amoxicillin-clavulanate, and oxytetracycline and two isolates were also resistant to vancomycin. Four patients with vancomycin-sensitive Enterococcus spp. were treated with vancomycin alone for mean periods of 18 days (14–21 days). One patient with vancomycin-resistant Enterococcus (VRE) meningitis was treated with linezolid alone, and another one requires combination with rifampicin to achieve microbiological clearance of CSF. CNS devices were removed in all patients. No mortality was reported in current case series. Conclusions: Enterococcal meningitis is very uncommon, mostly associated with neurosurgical intervention. Early treatment is associated with favorable outcomes. Removal of CNS devices is recommended to achieve a clinical cure.
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Affiliation(s)
- Iffat Khanum
- Department of Medicine, Liaquat National Hospital and Medical College, Karachi, Pakistan
| | - Sana Anwar
- Department of Microbiology, Liaquat National Hospital and Medical College, Karachi, Pakistan
| | - Aisha Farooque
- Department of Medicine, Liaquat National Hospital and Medical College, Karachi, Pakistan
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5
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Shettigar K, Bhat DV, Satyamoorthy K, Murali TS. Severity of drug resistance and co-existence of Enterococcus faecalis in diabetic foot ulcer infections. Folia Microbiol (Praha) 2017; 63:115-122. [PMID: 28889401 DOI: 10.1007/s12223-017-0547-2] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2017] [Accepted: 09/01/2017] [Indexed: 01/04/2023]
Abstract
The genes encoding aminoglycoside resistance in Enterococcus faecalis may promote collateral aminoglycoside resistance in polymicrobial wounds. We studied a total of 100 diabetic foot ulcer samples for infection and found 60 samples to be polymicrobial, 5 to be monomicrobial, and 35 samples to be culture negative. A total of 65 E. faecalis isolates were screened for six genes coding for aminoglycoside resistance, antibiotic resistance patterns, and biofilm production. Infectious Diseases Society of America/International Working Group on the Diabetic Foot system was used to classify the wound ulcers. Majority of the subjects with culture-positive wound were recommended conservative management, while 14 subjects underwent amputation. Enterococcal isolates showed higher resistance for erythromycin, tetracycline, and ciprofloxacin. Isolates from grade 3 ulcer showed higher frequency of aac(6')-Ie-aph(2″)-Ia, while all the isolates were negative for aph(2″)-Ib, aph(2″)-Ic, and aph(2″)-Id. The isolates from grade 3 ulcers showed higher resistance to aminoglycosides as well as teicoplanin and chloramphenicol. All the 39 biofilm producers were obtained from polymicrobial wound and showed higher resistance when compared to biofilm non-producers. Higher frequency of isolates carrying aac(6')-Ie-aph(2″)-Ia in polymicrobial community showing resistance to key antibiotics suggests widespread distribution of aminoglycoside-resistant E. faecalis and their role in worsening diabetic foot ulcers.
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Affiliation(s)
- Kavitha Shettigar
- Department of Biotechnology, School of Life Sciences, Manipal University, Manipal, 576104, India
| | - Deepika V Bhat
- Department of Biotechnology, School of Life Sciences, Manipal University, Manipal, 576104, India
| | - Kapaettu Satyamoorthy
- Department of Cellular and Molecular Biology, School of Life Sciences, Manipal University, Manipal, 576104, India
| | - Thokur Sreepathy Murali
- Department of Biotechnology, School of Life Sciences, Manipal University, Manipal, 576104, India.
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6
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Postneurosurgical Central Nervous System Infection Due to Enterococcus faecalis Successfully Treated With Intraventricular Vancomycin. INFECTIOUS DISEASES IN CLINICAL PRACTICE 2016; 24:174-176. [PMID: 27226704 PMCID: PMC4854177 DOI: 10.1097/ipc.0000000000000329] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Infections from Enterococcus faecalis and Enterococcus faecium are uncommon in the post-neurosurgical intervention setting., [1, 2, 3, 4] Intraventricular antibiotics are recommended when standard intravenous therapy fails. [5] Here we present a case of post-neurosurgical ventriculitis, meningitis, and cerebritis in an oncology patient caused by refractory Enterococcus faecalis successfully treated with intraventricular vancomycin.
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7
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Chen PY, Chu XN, Liu L, Hu JY. Effects of salinity and temperature on inactivation and repair potential of Enterococcus faecalis
following medium- and low-pressure ultraviolet irradiation. J Appl Microbiol 2016; 120:816-25. [DOI: 10.1111/jam.13026] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2015] [Revised: 10/19/2015] [Accepted: 10/30/2015] [Indexed: 11/29/2022]
Affiliation(s)
- P.-Y. Chen
- Department of Civil and Environmental Engineering; National University of Singapore; Singapore Singapore
| | - X.-N. Chu
- Department of Civil and Environmental Engineering; National University of Singapore; Singapore Singapore
| | - L. Liu
- Department of Civil and Environmental Engineering; National University of Singapore; Singapore Singapore
| | - J.-Y. Hu
- Department of Civil and Environmental Engineering; National University of Singapore; Singapore Singapore
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8
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Pukkila-Worley R, Nardi V, Branda JA. Case records of the Massachusetts General Hospital. Case 28-2014. A 39-year-old man with a rash, headache, fever, nausea, and photophobia. N Engl J Med 2014; 371:1051-60. [PMID: 25207769 DOI: 10.1056/nejmcpc1405886] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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9
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Abstract
Vancomycin-resistant enterococci (VRE) consist mainly of Enterococcus faecalis and E faecium, the latter mostly hospital-acquired. In addition, E gallinarum and E casseliflavus are intrinsically vancomycin-resistant and are community-acquired. VRE have become common in many hospitals throughout the world and, once established, are very difficult to eradicate. VRE are difficult to treat; therefore, infection control measures in hospitals are of prime importance in preventing the establishment of these pathogens. Most severe VRE infections will need combination therapy because many of the effective antimicrobial agents, when used alone, have only a bacteriostatic effect.
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Affiliation(s)
- Ethan Rubinstein
- Section of Infectious Diseases, Department of Internal Medicine and Medical Microbiology, University of Manitoba, 543-645 Bannatyne Ave, Basic Medical Building, Winnipeg, Manitoba R3E 0J9, Canada.
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10
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Inan D, Gunseren F, Colak D, Saba R, Kazan S, Mamikoglu L. First Confirmed Case of Vancomycin-ResistantEnterococcus faeciumMeningitis in Turkey:. J Chemother 2013; 16:608-11. [PMID: 15700856 DOI: 10.1179/joc.2004.16.6.608] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
Vancomycin-resistant enterococci are unusual etiologic agents of bacterial meningitis and pose significant therapeutic difficulties. We report the first confirmed case of nosocomial vancomycin-resistant Enterococcus faecium meningitis in Turkey. The patient was treated with chloramphenicol and cerebrospinal fluid cultures became negative, but clinical success was not achieved. We also review the previously reported cases of vancomycin-resistant Enterococcus faecium meningitis.
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Affiliation(s)
- D Inan
- Department of Infectious Diseases and Clinical Microbiology, Akdeniz University, Medicine Faculty, Antalya, Turkey.
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11
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Vancomycin-Resistant Enterococcus faecium Meningitis Successfully Treated With Daptomycin in Combination With Doxycycline and Linezolid. INFECTIOUS DISEASES IN CLINICAL PRACTICE 2011. [DOI: 10.1097/ipc.0b013e3181e85dcc] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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12
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Identification of Nor-β-Lapachone Derivatives as Potential Antibacterial Compounds against Enterococcus faecalis Clinical Strain. Curr Microbiol 2010; 62:684-9. [DOI: 10.1007/s00284-010-9763-6] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2010] [Accepted: 09/03/2010] [Indexed: 01/26/2023]
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13
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Guardado R, Asensi V, Torres JM, Pérez F, Blanco A, Maradona JA, Cartón JA. Post-surgical enterococcal meningitis: Clinical and epidemiological study of 20 cases. ACTA ACUST UNITED AC 2009; 38:584-8. [PMID: 16857599 DOI: 10.1080/00365540600606416] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Enterococcal post-surgical meningitis is an uncommon disease. 20 episodes of nosocomial post-surgical enterococcal meningitis diagnosed between 1994 and 2003 were retrospectively studied. During the period of study 20 cases of post-surgical enterococcal meningitis (60% female, mean age 55+/-18 y, range 16-78 y) were reviewed. The mean time between admission at the hospital and surgery was 26 (SD = 15) d (range 7-61 d). The most frequent underlying diseases were: intracerebral haemorrhage (55%), brain neoplasms (25%), head trauma (15%) and hydrocephalus (5%). 11 patients had previously received antibiotic treatment. The isolates identified were Enterococcus faecalis (n = 18) (90%), E. faecium (1) and E. durans (1). 11 patients had polymicrobial infections. The treatment most frequently used was vancomycin alone or with other antibiotics (11). In 5 patients intrathecal vancomycin (20 mg/d) was also added. The mortality rate was not different in intrathecally treated patients. Cerebrospinal fluid (CSF) devices were removed in 8 patients. Four patients died due to the infection. Mortality was significantly associated with lack of removal of the CSF devices (p = 0.04). Enterococcal spp. are a cause of nosocomial meningitis associated with neurosurgical procedures and the presence of neurological devices.
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14
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Varelas PN, Rehman M, Pierce W, Wellwood J, Chua T, Revankar S. Vancomycin-resistant enterococcal meningitis treated with intrathecal streptomycin. Clin Neurol Neurosurg 2007; 110:376-80. [PMID: 18162288 DOI: 10.1016/j.clineuro.2007.11.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2007] [Revised: 11/06/2007] [Accepted: 11/07/2007] [Indexed: 10/22/2022]
Abstract
Enterococcal meningitis is a rare complication of neurosurgical procedures. We present a patient who developed vancomycin-resistant enterococcal ventriculitis - meningitis after a brain tumor resection and ventriculoperitoneal shunt placement, treated successfully with intrathecal streptomycin through bilateral cerebrospinal fluid drainage catheters in addition to systemic antibiotics. This is the first report of such treatment for this resistant organism.
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15
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Pintado V, Cabellos C, Moreno S, Meseguer MA, Ayats J, Viladrich PF. Enterococcal meningitis: a clinical study of 39 cases and review of the literature. Medicine (Baltimore) 2003; 82:346-64. [PMID: 14530784 DOI: 10.1097/01.md.0000090402.56130.82] [Citation(s) in RCA: 66] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
To describe the clinical features and outcome of enterococcal meningitis, we retrospectively reviewed the charts of 39 cases seen at 2 tertiary hospitals during a 25 years and collected 101 additional, previously reported cases for review. Among these 140 cases, there were 82 cases (59%) of postoperative meningitis and 58 cases (41%) of spontaneous meningitis. Eighty-six patients (61%) were adults and 54 (39%) were children. Patients with spontaneous meningitis had a higher frequency of community-acquired infection (50% versus 18%; p < 0.01), severe underlying diseases (67% versus 22%; p < 0.01), and associated enterococcal infection (29% versus 8%; p < 0.01) than patients with postoperative meningitis. The clinical presentation was similar in both groups, but patients with spontaneous infection had a higher frequency of bacteremia (58% versus 12%; p < 0.01), and a lower frequency of mixed infection (9% versus 29%; p < 0.01). Spontaneous meningitis in children was associated with a significantly lower frequency of fever, altered mental status, headache, and meningeal signs (p < 0.01), probably explained by the high proportion of neonates in this age-group. Most infections were caused by Enterococcus faecalis, which accounted for 76% of the isolates identified at the species level. Fifteen of the 25 cases due to Enterococcus faecium were produced by vancomycin-resistant strains. Most patients were treated with ampicillin, penicillin, or vancomycin, with or without aminoglycosides, for a median period of 18 days (range, 1-85 d). Overall mortality was 21%. The mortality rate was higher in spontaneous than in postoperative meningitis (33% versus 12%; p < 0.01), but was similar in patients treated with beta-lactams (18%), glycopeptides (14%), or other antibiotics (25%), as well as in patients treated with monotherapy (16%) or combination therapy (22%). An adverse outcome correlated significantly with advanced age, the presence of severe underlying diseases, associated enterococcal infection, bacteremia, septic shock, and the absence of fever at presentation. Shunt removal was associated with a lower mortality. Multivariate analysis showed that the presence of severe underlying diseases was the only prognostic factor associated with mortality (odds ratio = 6.8, 95% confidence intervals = 2.7-17.5, p < 0.01).
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Affiliation(s)
- Vicente Pintado
- Infectious Diseases Department, Hospital Ramón y Cajal, Carretera de Colmenar km 9.1, 28034 Madrid, Spain.
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Abstract
Helicobacter pylori infection is the most common cause of gastritis with its associated sequelae. Gastritis secondary to other bacteria is rare. This report describes Enterococcus-associated gastritis in a 59-year-old diabetic man. Nine months after receiving treatment for H. pylori-associated gastritis, he underwent endoscopy to confirm H. pylori eradication and to evaluate the status of previously seen ulcers. Mucosal biopsy specimens revealed severe active but focal gastritis adjacent to gram-positive coccobacilli in short to long chains with no H. pylori. Culture grew an Enterococcus similar to E. hirae and E. durans. No treatment was given, and endoscopy done 2 months later showed complete resolution of the gastritis and absence of H. pylori or enterococci. Our patient's gastritis represents a previously undescribed manifestation of Enterococcus infection. It is possible that the presence of NSAID gastric mucosal injury and diabetes predisposed this individual to the development of transient Enterococcus gastritis.
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Affiliation(s)
- Hala M T El-Zimaity
- Department of Medicine, Veterans Affairs Medical Center, Houston, TX 77030, USA
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17
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Kanchanapoom T, Koirala J, Goodrich J, Agamah E, Khardori N. Treatment of central nervous system infection by vancomycin-resistant enterococcus faecium. Diagn Microbiol Infect Dis 2003; 45:213-5. [PMID: 12663164 DOI: 10.1016/s0732-8893(02)00523-0] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Enterococci are uncommon causes of CNS infection. We describe a case of ventriculitis and Ommaya reservoir infection due to vancomycin-resistant Enterococcus faecium successfully treated with the combination of i.v. quinupristin/dalfopristin and i.v. linezolid. The patient deteriorated after receiving three dosages of intraventricular quinupristin/dalfopristin. He recovered after discontinuation of intraventricular quinupristin/dalfopristin.
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18
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Tsukada Y, Nagayama H, Mori T, Shimizu T, Sato N, Takayama N, Ishida A, Handa M, Ikeda Y, Okamoto S. Granulocyte transfusion as a treatment for enterococcal meningoencephalitis after allogeneic bone marrow transplantation from an unrelated donor. Bone Marrow Transplant 2003; 31:69-72. [PMID: 12621511 DOI: 10.1038/sj.bmt.1703780] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Bacterial meningoencephalitis occurring in the pre-engraftment period after bone marrow transplantation (BMT) is a rare complication, and the feasibility of granulocyte transfusion (GTX) in such cases remains to be elucidated. A 37-year-old man developed enterococcal meningoencephalitis during a severely granulocytopenic pre-engraftment period after BMT. Despite therapy with appropriate antibiotics, cultures of blood and cerebro-spinal fluid (CSF) continued to grow Enterococcus faecalis, and he developed rapid mental deterioration and seizure. Granulocytes were collected from his HLA-mismatched, ABO-matched sibling with subcutaneous injection of granulocyte colony-stimulating factor (G-CSF) and oral dexamethazone. Transfusion of 4.4 x 10(10) granulocytes resulted in a 12-h post-transfusion granulocyte increment of 2.0 x 10(9)/l, and maintained peripheral blood granulocyte counts above 0.5 x 10(9)/l for 3 days. A rapid increase of granulocytes in CSF was also observed, and cultures of blood and CSF became negative after GTX. A transient worsening of seizure was observed as a potential side effect of GTX. The patient subsequently developed septic shock because of Pseudomonas aeruginosa and died. Further studies are warranted to evaluate the clinical efficacy of GTX for the treatment of uncontrolled infections in granulocytopenic stem cell transplant recipients.
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Affiliation(s)
- Y Tsukada
- Department of Medicine, Keio University School of Medicine, Tokyo, Japan
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Abstract
Along with the successes in improving the survival of preterm neonates have come changes in the epidemiology of pathogens that cause healthcare-associated infections. Although gram-negative bacilli and group B streptococci predominated in past years, gram-positive organisms such as staphylococci and enterococci have since taken on greater roles. This shift has been accompanied by difficulties in defining optimal treatments for these pathogens because of emerging resistance patterns.
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Affiliation(s)
- Philip L Graham
- Division of Infectious Diseases, Department of Pediatrics, Columbia University, New York, NY 10032, USA.
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20
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Abstract
The successful treatment of a 7-month-old infant with shunt-associated ventriculitis caused by vancomycin-resistant Enterococcus faecium is presented. Linezolid was administered intravenously every 8 h; children have a greater volume of distribution and total body clearance than adults and therefore require more frequent dosing. The patient tolerated the therapy without adverse effects.
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Affiliation(s)
- Philip L Graham
- Departments of Pediatrics and Epidemiology, Columbia, University, New York, NY 10032, USA.
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21
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Lu HZ, Weng XH, Li H, Yin YK, Pang MY, Tang YW. Enterococcus faecium-related outbreak with molecular evidence of transmission from pigs to humans. J Clin Microbiol 2002; 40:913-7. [PMID: 11880415 PMCID: PMC120277 DOI: 10.1128/jcm.40.3.913-917.2002] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Between 24 July and 31 August 1998, thousands of domestic pigs died of hemorrhagic shock in three adjunct counties along the YangZi River in Jiangshu Province, China. From 28 July to 6 September 1998, 40 local farmers (36 males and 4 females, ages 23 to 78 years) were hospitalized with severe illness characterized by high fever, erythematous rash or petechiae, and profound lethargy after contact with sick pigs. Twelve (30%) of these patients died of respiratory failure and shock. Eleven bacterial isolates recovered from 11 blood and cerebrospinal fluid specimens collected from seven patients and two pigs were identified as Enterococcus faecium based on biochemical reactions and 16S rRNA gene sequence analysis. Both pig and human E. faecium isolates displayed indistinguishable antibiotic susceptibility and pulsed-field gel electrophoresis patterns. These data strongly suggest the spread of an outbreak of E. faecium-related sepsis from pigs to humans.
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Affiliation(s)
- Hong-Zhou Lu
- Department of Infectious Diseases, Huashan Hospital, Fudan University, Shanghai 200040, People's Republic of China
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23
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Steinmetz MP, Vogelbaum MA, De Georgia MA, Andrefsky JC, Isada C. Successful treatment of vancomycin-resistant enterococcus meningitis with linezolid: Case report and review of the literature. Crit Care Med 2001; 29:2383-5. [PMID: 11801846 DOI: 10.1097/00003246-200112000-00023] [Citation(s) in RCA: 50] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To describe the successful treatment of a case of vancomycin-resistant enterococcus meningitis with linezolid. DESIGN Case report and review of the literature. PATIENTS The patient is a 35-yr-old man who suffered a cerebellar hemorrhage after embolization of a cerebellar arteriovenous malformation. The patient underwent ventriculostomy drainage and craniectomy. The patient was on broad-spectrum antibiotics for pneumonia including vancomycin. The patient remained febrile and grew vancomycin-resistant Enterococcus faecium from the cerebrospinal fluid. INTERVENTIONS The patient was treated with intravenous chloramphenicol without success. On postoperative day 16, the patient was begun on intravenous linezolid. MAIN RESULTS The patient received 4 wks of intravenous linezolid with complete eradication of the meningitis. CONCLUSIONS Intravenous linezolid appears to be a safe and effective therapy for vancomycin-resistant enterococcus meningitis.
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Affiliation(s)
- M P Steinmetz
- Department of Neurosurgery, Cleveland Clinic Foundation, Cleveland, OH, USA
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24
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Zeana C, Kubin CJ, Della-Latta P, Hammer SM. Vancomycin-resistant Enterococcus faecium meningitis successfully managed with linezolid: case report and review of the literature. Clin Infect Dis 2001; 33:477-82. [PMID: 11462183 DOI: 10.1086/321896] [Citation(s) in RCA: 107] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2000] [Revised: 12/22/2000] [Indexed: 11/03/2022] Open
Abstract
Enterococci cause serious illness in immunocompromised patients and severely ill, hospitalized patients. Resistance to vancomycin has increased in frequency during the past few years. Limited therapeutic options are available for vancomycin-resistant enterococcal infections and the optimum therapy has not been established. We report a case of nosocomial vancomycin-resistant Enterococcus faecium meningitis in the setting of hyperinfection with Strongyloides stercoralis that was successfully treated with linezolid. We also review the previously reported cases of vancomycin-resistant E. faecium meningitis.
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Affiliation(s)
- C Zeana
- Department of Medicine, Division of Infectious Diseases, Columbia University College of Physicians and Surgeons, 630 W. 168th St., New York, NY 10032, USA.
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25
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Abstract
The treatment of severe enterococcal infections based on the currently available antibacterial agents is difficult. The help of the microbiology laboratory for determining MICs, MBCs, and most effective synergistic combinations is crucial. There is a need for good prospective multicenter clinical trials to improve the prognosis of such infections by defining therapeutic strategies better. Such a requirement is highly suitable for the treatment of infections caused by enterococci exhibiting acquired resistance mechanisms to the available agents. The current clinical development of new compounds looks promising in these persistently life-threatening infections mostly occurring in deficient hosts.
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Affiliation(s)
- A Lefort
- Service de Médecine Interne, Hôpital Beaujon, Clichy, France
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26
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Affiliation(s)
- R O Suara
- Department of Pediatrics, Vanderbilt University School of Medicine, Nashville, TN, USA
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Zanella RC, Valdetaro F, Lovgren M, Tyrrel GJ, Bokermann S, Almeida SC, Vieira VS, Brandileone MC. First confirmed case of a vancomycin-resistant Enterococcus faecium with vanA phenotype from Brazil: isolation from a meningitis case in São Paulo. Microb Drug Resist 2000; 5:159-62. [PMID: 10432277 DOI: 10.1089/mdr.1999.5.159] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
The importance of enterococci as a nosocomial etiologic agent is well documented; however, enterococci are also capable of causing a variety of community-acquired infections. Vancomycin resistance in a clinical Enterococcus isolate was first reported in 1986, and since then vancomycin-resistant enterococci (VRE) have been reported world-wide. This report describes a case of E. faecium with the VanA phenotype, isolated from meningitis in Sao Paulo, Brazil. Two E. faecium strains were isolated. One strain showed VanA phenotype, and the molecular characterization of the VanA gene was confirmed by polymerase chain reaction. The other strain was susceptible to vancomycin and teicoplanin. The authors would like to call the attention of the scientific community to this first identification of a VRE case in Sao Paulo, Brazil.
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Affiliation(s)
- R C Zanella
- Seção de Bacteriologia, Adolfe Lutz Institute, São Paulo, Brazil
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28
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Pérez Mato S, Robinson S, Bégué RE. Vancomycin-resistant Enterococcus faecium meningitis successfully treated with chloramphenicol. Pediatr Infect Dis J 1999; 18:483-4. [PMID: 10353532 DOI: 10.1097/00006454-199905000-00023] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- S Pérez Mato
- Department of Pediatrics, Louisiana State University School of Medicine, Children's Hospital, New Orleans, USA
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29
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Lin DP, Wada S, Jimenez-Lucho VE. Enterococcus faecalis endocarditis presenting as meningitis. Infection 1998; 26:304-5. [PMID: 9795790 DOI: 10.1007/bf02962253] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Although Enterococcus faecalis is a relatively common cause of infective endocarditis, it rarely causes meningitis. A case of Enterococcus faecalis endocarditis presenting as meningitis in a 74-year-old diabetic man on chronic hemodialysis is reported. A review of the literature showed that the association of enterococcal meningitis and endocarditis has rarely been reported. This clinical association may be more common than previously recognized and it is suggested that echocardiography be considered for all patients with enterococcal hematogenous meningitis in order to rule out endocarditis.
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Affiliation(s)
- D P Lin
- Medical Service, Northport Veterans Administration Medical Center, NY 11768-2290, USA
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30
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Jones BL, Wilcox MH. Subdural empyema due to Enterococcus faecalis. SCANDINAVIAN JOURNAL OF INFECTIOUS DISEASES 1997; 29:627-628. [PMID: 9571746 DOI: 10.3109/00365549709035907] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
Abstract
Central nervous system infections due to Enterococcus species are uncommon. We report the first case of subdural empyema due to Enterococcus faecalis. Following partial treatment of a middle ear infection due to Enterococcus species and mixed coliforms, the patient developed signs of meningeal involvement. A lumbar puncture showed a raised polymorph cell count, but was sterile on culture; broad-spectrum antimicrobial therapy with cefotaxime, flucloxacillin and metronidazole was commenced. Following development of focal neurological signs, a CT scan revealed a subdural collection. Drainage and culture of the pus yielded a pure growth of Enterococcus faecalis. This case demonstrates the need to remain aware of the ability of the Enterococcus to cause serious infections and to direct specific antimicrobial therapy accordingly.
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Affiliation(s)
- B L Jones
- Clinical Microbiology and Public Health Laboratory, Addenbrooke's Hospital, Cambridge, UK
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31
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Patel R, Badley AD, Larson-Keller J, Harmsen WS, Ilstrup DM, Wiesner RH, Steers JL, Krom RA, Portela D, Cockerill FR, Paya CV. Relevance and risk factors of enterococcal bacteremia following liver transplantation. Transplantation 1996; 61:1192-7. [PMID: 8610417 DOI: 10.1097/00007890-199604270-00013] [Citation(s) in RCA: 38] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
To analyze the clinical characteristics of and identify specific risk factors for enterococcal bacteremia following liver transplantation, we performed a study in 405 consecutive liver transplantation recipients prophylaxed with a selective bowel decontamination regimen. Seventy enterococcal bacteremias in 52 patients were identified. Enterococcus faecalis (50) outnumbered Enterococcus faecium isolates (18), and 49% of enterococcal bacteremias were polymicrobial. Biliary tree complications were present in 34% of enterococcal bacteremias. Of the 15 deaths (29%) among the patients with enterococcal bacteremia, 4 were directly associated with enterococcal bacteremia. In a multivariate analysis, Roux-en-Y choledochojejunostomy (P=0.005), a cytomegalovirus-seropositive donor (P=0.013), prolonged transplantation time (P=0.02), and biliary stricturing (P=0.016) were identified as significant risk factors. Other risk factors identified in a univariate analysis included primary sclerosing cholangitis (P=0.009) and symptomatic cytomegalovirus infection (P=0.008). Enterococcal bacteremia is a frequent infectious complication in liver transplantation recipients receiving selective bowel decontamination. Its association with cytomegalovirus and biliary tree abnormalities suggest specific areas for prophylactic intervention.
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Affiliation(s)
- R Patel
- Division of Infectious Diseases, Mayo Clinic, Rochester, MN 55905, USA
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