Vancomycin-resistant Enterococcus faecium Empyema in an Asplenic Patient

Detection of Vancomycin-Resistant Enterococci and Vancomycin Resistance Genes in Patients Hospitalized in the Pediatric Intensive Care Unit

Objective: Vancomycin-resistant enterococci (VRE) infection and colonization are seen increasingly frequently, especially among intensive care unit (ICU) patients. In this study, the aim was to detect VRE in swab samples taken from patients hospitalized in the Pediatric ICU (PICU), colonization, and to investigate the clonal relationship between isolates. Materials and Methods: In the present study, swab samples were taken from the external auditory canal (EAC), umbilical region, and rectal region from 82 patients hospitalized in the Çukurova University Balcalı Hospital PICU. The 246 swab samples from patients were inoculated on Kanamycin-Esculin-Azide agar. Isolates were identified with the help of the BBL Crystal Gram-Positive identification system. The susceptibility of the isolates to vancomycin (30 µg) was investigated by Kirby-Bauer disk diffusion method according to CLSI criteria. VanA-VanB genes in phenotypically defined vancomycin-resistant enterococci were investigated by Polymerase Chain Reaction (PCR) method. The clonal relationship between vancomycin-susceptible (VSE) and -resistant enterococci was determined by the SmaI-PFGE method. Results: A total of 49 (20.3%) enterococcal strains were isolated from 246 swab samples from the patients, of which 14 (28.5%) were VRE. Of the enterococci isolates, 27 (55.10%) were E. faecium and 13 (26.53%) were E. feacalis. While VanA type resistance was detected in 11 of the vancomycin-resistant E. faecium and E. feacalis isolates, VanB type resistance was not detected in any sample. There was no significant clonal relationship between the isolates. Conclusion: Although the prevalence of VRE in the PICU was high throughout the study, no enterococcal infection was observed.

Pleural empyema due to Enterococcus species: An uncommon etiology

We report a case of empyema due to Enterococcus faecium in a 50-year-old woman with no apparent severe immune system impairment, except for underlying thyroid disorder and hypochromic anaemia. Appropriate antibiotic therapy with parenteral amoxicillin-clavulanate with gentamicin, tube drainage and other supportive therapy resulted in a favourable outcome and the patient was discharged after 3 weeks of hospitalization. Though uncommon, the possibility of Enteroccus species should be kept in mind as a causative agent of thoracic empyema, especially in adults presenting from the community.

Vancomycin-resistant Enterococcus faecium pneumonia in a uremic patient on hemodialysis: a case report and review of the literature

Background

Even though enterococci can cause serious infections in multiple sites, they are a rare cause of pneumonia. We reported a uremic patient with vancomycin-resistant E. faecium (VRE-fm) pneumonia, possibly related to epileptic seizures.

Case presentation

A 57-year old man with uremia on hemodialysis was admitted to the hospital with complaint of recurrent epileptic seizures, followed by a two-week history of recurrent fever and cough with purulent sputum. Chest CT demonstrated multiple exudation of both lungs. He was diagnosed as community acquired pneumonia. Despite antibiotic combination therapy, abnormal chest shadows aggravated. Sputum and blood cultures were initially negative, but later blood culture grew VRE-fm. We suspected aspiration of gastrointestinal content induced by epilepsy as the most likely mechanism. The patient was successfully treated with a four-week course of linezolid according to the antibiotic susceptibility testing.

Conclusions

Physicians should consider multi-drug resistant organisms such as VRE in uremic patients with pneumonia that fails to resolve with broad-spectrum antibiotics, especially in the cases with aspiration induced by epilepsy, immunocompromised conditions, and repeated or prolonged hospitalizations.