University of Pittsburgh School of Medicine, Pennsylvania.
Departments of Medicine, University of Pittsburgh School of Medicine, Pennsylvania.
J Pediatric Infect Dis Soc. 2019 Dec 27;8(6):571-573. doi: 10.1093/jpids/piz028.
Enterococcus hirae is a gram-positive coccus that is rarely implicated in human disease and has not been reported in pediatric patients. We report a case of catheter-associated bloodstream infection and prolonged bacteremia in a 7-month-old infant dependent on total parenteral nutrition. The species was identified by the VITEK2 system and confirmed by matrix-assisted laser desorption/ionization time-of-flight (MALDI-TOF) mass spectrometry. The organisms was susceptible to ampicillin, vancomycin, and high-level gentamicin. The patient was treated with vancomycin and gentamicin with adjunctive vancomycin lock therapy but had persistent bacteremia. Therapy was changed to dual β-lactam therapy of ampicillin and ceftriaxone with synergistic gentamicin, which led to clearance of the enterococcal bacteremia. E hirae is an unusual species that may be difficult for the microbiology laboratory to identify. This is the first pediatric case and the second case of invasive E hirae in the United States.
海氏肠球菌是一种革兰阳性球菌，很少与人类疾病有关，也未在儿科患者中报道过。我们报告了一例依赖全胃肠外营养的 7 个月大婴儿的导管相关性血流感染和持续性菌血症。该菌通过 VITEK2 系统鉴定，并通过基质辅助激光解吸/电离飞行时间（MALDI-TOF）质谱法确认。该菌对氨苄西林、万古霉素和高水平庆大霉素敏感。患者接受万古霉素和庆大霉素治疗，并辅以万古霉素封管治疗，但仍持续菌血症。治疗方案改为氨苄西林和头孢曲松的双联β-内酰胺治疗，并协同使用庆大霉素，这导致肠球菌菌血症清除。海氏肠球菌是一种不常见的菌种，可能难以被微生物实验室识别。这是首例儿科病例，也是美国的第二例侵袭性海氏肠球菌感染病例。
