Cunha Burke A, Mickail Nardeen, Eisenstein Lawrence
Infectious Disease Division, Winthrop-University Hospital, Mineola, and the State University of New York School of Medicine, Stony Brook, New York, USA.
Heart Lung. 2007 Nov-Dec;36(6):456-61. doi: 10.1016/j.hrtlng.2007.02.012.
Enterococci are part of the normal flora of the gastrointestinal tract. Intra-abdominal and genitourinary enterococcal infections may be complicated by enterococcal bacteremia. Most strains of enterococci fecal flora in antibiotic-naive patients are E. faecalis. Because nearly all E. faecalis strains are sensitive to vancomycin, E. faecalis is synonymous with vancomycin-sensitive enterococci (VSE). E. faecium, which is nearly always vancomycin-resistant, is termed vancomycin-resistant enterococci (VRE). High-grade continuous enterococcal bacteremias may result in endocarditis. Persistent VSE and VRE bacteremias may be related to device-associated infections; intra-abdominal, pelvic, and/or renal abscesses; or enterococcal endocarditis. If these causes of persistent enterococcal bacteremia are eliminated, microbiologic and antimicrobial therapy-related causes for persistent bacteremia should be considered. We present a case of a male with a E. faecalis (VSE) bacteremia unresponsive to parenteral vancomycin therapy but sensitive to vancomycin in vitro (minimum inhibitory concentration [MIC] = 1 microg/mL). The patient was treated with high-dose daptomycin (12 mg/kg intravenously [IV] q 24 hours) empirically pending susceptibility testing. High-dose daptomycin therapy cleared the patient's E. faecalis bacteremia. Subsequently, it was determined that the strain of E. faecalis was "tolerant" of vancomycin (MIC = 1 microg/mL, MBC = >64 microg/mL). We believe this is the first case of enterococcal (VSE) bacteremia unresponsive to vancomycin tolerant strain of E. faecalis that responded to high-dose daptomycin (12 mg/kg IV q 24 hours) therapy.
肠球菌是胃肠道正常菌群的一部分。腹腔内和泌尿生殖道的肠球菌感染可能并发肠球菌菌血症。在未使用过抗生素的患者中，大多数肠道菌群中的肠球菌菌株为粪肠球菌。由于几乎所有粪肠球菌菌株对万古霉素敏感，粪肠球菌等同于万古霉素敏感肠球菌（VSE）。屎肠球菌几乎总是对万古霉素耐药，被称为万古霉素耐药肠球菌（VRE）。高度持续性肠球菌菌血症可能导致心内膜炎。持续性VSE和VRE菌血症可能与器械相关感染、腹腔内、盆腔和/或肾脓肿或肠球菌心内膜炎有关。如果消除了这些持续性肠球菌菌血症的病因，应考虑微生物学和抗菌治疗相关的持续性菌血症病因。我们报告一例男性粪肠球菌（VSE）菌血症患者，该患者对静脉注射万古霉素治疗无反应，但体外对万古霉素敏感（最低抑菌浓度[MIC]=1微克/毫升）。在等待药敏试验期间，该患者经验性地接受了高剂量达托霉素（12毫克/千克静脉注射[IV]，每24小时一次）治疗。高剂量达托霉素治疗清除了患者的粪肠球菌菌血症。随后，确定该粪肠球菌菌株对万古霉素“耐受”（MIC=1微克/毫升，MBC>64微克/毫升）。我们认为这是首例对万古霉素耐药的粪肠球菌菌株引起的肠球菌（VSE）菌血症，该菌株对高剂量达托霉素（12毫克/千克静脉注射，每24小时一次）治疗有反应。
