Department of Infectious Diseases, St. Luke's International Hospital, 9-1, Akashi-cho, Chuo-ku, Tokyo, Japan.
St. Luke's International University Library, Tokyo, Japan.
BMC Infect Dis. 2021 Sep 23;21(1):999. doi: 10.1186/s12879-021-06707-2.
Infections caused by Enterococcus hirae are common in animals, with instances of transmission to humans being rare. Further, few cases have been reported in humans because of the difficulty in identifying the bacteria. Herein, we report a case of pyelonephritis caused by E. hirae bacteremia and conduct a literature review on E. hirae bacteremia.
A 57-year-old male patient with alcoholic cirrhosis and neurogenic bladder presented with fever and chills that had persisted for 3 days. Physical examination revealed tenderness of the right costovertebral angle. Matrix-assisted laser desorption ionization-time of flight mass spectrometry (MALDI-TOF MS) of the patient's blood and urine samples revealed the presence of E. hirae, and pyelonephritis was diagnosed. The patient was treated successfully with intravenous ampicillin followed by oral linezolid for a total of three weeks.
The literature review we conducted revealed that E. hirae bacteremia is frequently reported in urinary tract infections, biliary tract infections, and infective endocarditis and is more likely to occur in patients with diabetes, liver cirrhosis, and chronic kidney disease. However, mortality is not common because of the high antimicrobial susceptibility of E. hirae. With the advancements in MALDI-TOF MS, the number of reports of E. hirae infections has also increased, and clinicians need to consider E. hirae as a possible causative pathogen of urinary tract infections in patients with known risk factors.
海氏肠球菌引起的感染在动物中很常见，很少有传播给人类的情况。此外，由于难以识别细菌，人类感染的病例也很少报告。本文报告了一例由海氏肠球菌菌血症引起的肾盂肾炎，并对海氏肠球菌菌血症进行了文献复习。
一名 57 岁男性患者，患有酒精性肝硬化和神经性膀胱，出现发热和寒战，持续 3 天。体格检查发现右侧肋脊角压痛。对患者的血液和尿液样本进行基质辅助激光解吸电离飞行时间质谱（MALDI-TOF MS）检测显示存在海氏肠球菌，诊断为肾盂肾炎。患者接受静脉注射氨苄西林后口服利奈唑胺治疗，总疗程为 3 周，治疗成功。
我们进行的文献复习表明，海氏肠球菌菌血症常发生于尿路感染、胆道感染和感染性心内膜炎，在糖尿病、肝硬化和慢性肾脏病患者中更易发生。然而，由于海氏肠球菌具有较高的抗菌药物敏感性，因此死亡率并不常见。随着 MALDI-TOF MS 的进步，海氏肠球菌感染的报告数量也有所增加，临床医生需要考虑海氏肠球菌是有已知危险因素的尿路感染患者的潜在致病病原体。
