Department of Nephrology, Shanghai Tongren Hospital, Shanghai Jiao Tong University School of Medicine, 1111 Xianxia Road, Shanghai, 200336, China.
BMC Infect Dis. 2020 Feb 22;20(1):167. doi: 10.1186/s12879-020-4892-4.
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.
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.
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.
肠球菌可引起多个部位的严重感染，但很少引起肺炎。我们报告了一例尿毒症患者感染万古霉素耐药粪肠球菌（VRE-fm）肺炎，可能与癫痫发作有关。
一名 57 岁男性，因尿毒症接受血液透析，因反复癫痫发作入院，随后出现两周发热、咳嗽、咳脓性痰。胸部 CT 显示双肺多个渗出影。诊断为社区获得性肺炎。尽管给予抗生素联合治疗，异常的胸部阴影仍在加重。痰和血培养最初为阴性，但后来血培养出 VRE-fm。我们怀疑癫痫发作引起的胃肠道内容物吸入是最可能的机制。根据药敏试验，该患者成功接受了为期四周的利奈唑胺治疗。
对于因广谱抗生素治疗无效而导致肺炎的尿毒症患者，医生应考虑多重耐药菌（如 VRE），特别是在癫痫发作、免疫功能低下、反复或长期住院引起的吸入情况下。
