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Abstract

Introduction. Enterococcus faecium is a commensal organism commonly colonizing the human gastrointestinal tract. Although it is generally a non-virulent organism, E. faecium can cause significant morbidity and mortality due to its inherent and acquired resistances to commonly used antimicrobials. Patients who are immunosuppressed are particularly vulnerable.

Case presentation. A 65–75-year-old patient with a history of an orthotopic liver transplant for hepatitis C infection and diabetes was re-admitted to the hospital with abdominal pain and fever. The patient had several recent admissions related to the presentation reported here, which included treatment with a prolonged course of broad-spectrum antibiotics. The patient was found to have a recurrent liver abscess and blood cultures grew vancomycin-resistant E. faecium, non-susceptible to all tested agents: ampicillin, penicillin, vancomycin, daptomycin and linezolid. The patient was started initially on chloramphenicol intravenously while awaiting additional susceptibility testing, which ultimately revealed chloramphenicol non-susceptibility. Tigecycline was started but the patient ultimately decided to pursue hospice care.

Conclusion. Multi-drug-resistant organisms are increasingly being recognized and are associated with poorer outcomes, particularly in immunosuppressed patients. We describe a particularly resistant organism and discuss potential therapeutic options.

  • This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
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2018-12-20
2022-01-19
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References

  1. Arias CA, Murray BE. The rise of the Enterococcus: beyond vancomycin resistance. Nat Rev Microbiol 2012; 10:266–278 [View Article][PubMed]
    [Google Scholar]
  2. Prematunge C, MacDougall C, Johnstone J, Adomako K, Lam F et al. VRE and VSE bacteremia outcomes in the era of effective vre therapy: a systematic review and meta-analysis. Infect Control Hosp Epidemiol 2016; 37:26–35 [View Article][PubMed]
    [Google Scholar]
  3. Patel G, Snydman DR. AST Infectious Diseases Community of Practice Vancomycin-resistant Enterococcus infections in solid organ transplantation. Am J Transplant 2013; 13 (Suppl. 4):59–67 [View Article][PubMed]
    [Google Scholar]
  4. Arias CA, Contreras GA, Murray BE. Management of multidrug-resistant enterococcal infections. Clin Microbiol Infect 2010; 16:555–562 [View Article][PubMed]
    [Google Scholar]
  5. Mermel LA, Allon M, Bouza E, Craven DE, Flynn P et al. Clinical practice guidelines for the diagnosis and management of intravascular catheter-related infection: 2009. Update by the Infectious Diseases Society of America. Clin Infect Dis 2009; 49:1–45 [View Article][PubMed]
    [Google Scholar]
  6. FDA. FDA Warns of Increased Risk of Death with IV Antibacterial Tygacil (Tigecycline) and Approves New Boxed Warning. Silver Spring, MD:: U.S. Food and Drug Administration;; 2013
    [Google Scholar]
  7. Arias CA, Mendes RE, Stilwell MG, Jones RN, Murray BE. Unmet needs and prospects for oritavancin in the management of vancomycin-resistant enterococcal infections. Clin Infect Dis 2012; 54:S233–S238 [View Article][PubMed]
    [Google Scholar]
  8. Stryjewski ME, Graham DR, Wilson SE, O'Riordan W, Young D et al. Telavancin versus vancomycin for the treatment of complicated skin and skin-structure infections caused by gram-positive organisms. Clin Infect Dis 2008; 46:1683–1693 [View Article][PubMed]
    [Google Scholar]
  9. Barnhill AE, Brewer MT, Carlson SA. Adverse effects of antimicrobials via predictable or idiosyncratic inhibition of host mitochondrial components. Antimicrob Agents Chemother 2012; 56:4046–4051 [View Article][PubMed]
    [Google Scholar]
  10. Yunis AA. Chloramphenicol toxicity: 25 years of research. Am J Med 1989; 87:44n–48n[PubMed]
    [Google Scholar]
  11. Gould CV, Fishman NO, Nachamkin I, Lautenbach E. Chloramphenicol resistance in vancomycin-resistant enterococcal bacteremia: impact of prior fluoroquinolone use?. Infect Control Hosp Epidemiol 2004; 25:138–145 [View Article][PubMed]
    [Google Scholar]
  12. Lynch C, Courvalin P, Nikaido H. Active efflux of antimicrobial agents in wild-type strains of enterococci. Antimicrob Agents Chemother 1997; 41:869–871 [View Article][PubMed]
    [Google Scholar]
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