Huang Xiao-Qing, Qiu Jun-Ke, Wang Cai-Hong, Pan Lei, Xu Jie-Kun, Pan Xiao-Hong, Ji Xiao-Bo, Mao Min-Jie
Department of Tuberculosis Intensive Care Unit Tuberculosis Diagnosis and Treatment Center of Zhejiang Province, Hang Zhou Red Cross Hospital, Hang Zhou, China.
Medicine (Baltimore). 2020 Jul 2;99(27):e19811. doi: 10.1097/MD.0000000000019811.
Nosocomial Enterococcus faecium (E faecium) infections are common among immunocompromised patients; however, sepsis caused by E faecium is rarely encountered in the clinical setting.
A 69-year-old woman with a previous history of tuberculosis (TB), developed symptoms of recurrent fever, paroxysmal cough, and exertional dyspnea for over 2 months before she presented to the hospital.
The patient was initially misdiagnosed with recurrent TB, and did not respond to anti-TB therapy. Culture results of blood, endotracheal necrotic tissue, and urine confirmed a diagnosis of multifocal E faecium infection.
On definitive diagnosis, the patient received intensive antimicrobial combination treatment with linezolid, teicoplanin, caspofungin, and voriconazole on the basis of antimicrobial susceptibility results.
After transient improvement, the patient's condition deteriorated due to secondary infections, and the patient died after discharge against medical advice.
E faecium bacteremia may cause sepsis in immunocompromised patients, and has a high mortality rate. Careful pathogen detection and early initiation of treatment is crucial to good patient outcome.
医院获得性粪肠球菌感染在免疫功能低下患者中很常见；然而，临床环境中很少遇到由粪肠球菌引起的败血症。
一名69岁女性，既往有结核病病史，在入院前2个多月出现反复发热、阵发性咳嗽和劳力性呼吸困难症状。
患者最初被误诊为复发性结核病，抗结核治疗无效。血液、气管内坏死组织和尿液的培养结果确诊为多灶性粪肠球菌感染。
确诊后，根据药敏结果，患者接受了利奈唑胺、替考拉宁、卡泊芬净和伏立康唑的强化抗菌联合治疗。
短暂改善后，患者病情因继发感染恶化，患者在违背医嘱出院后死亡。
粪肠球菌菌血症可能导致免疫功能低下患者发生败血症，死亡率很高。仔细的病原体检测和早期开始治疗对患者的良好预后至关重要。
