[Bacteremia caused by vancomycin-resistant Enterococcus faecalis. Report of 2 cases]

Area of Science:

• Infectious Diseases
• Clinical Microbiology
• Hospital Epidemiology

Background:

• Nosocomial bacteremia is a significant concern in healthcare settings.
• Enterococcus faecalis is a common cause of hospital-acquired infections.
• Vancomycin resistance in E. faecalis poses a therapeutic challenge.

Observation:

• Two distinct cases of nosocomial bacteremia caused by vancomycin-resistant E. faecalis were identified in Spanish hospitals.
• Both patients, a 78-year-old male and a 65-year-old female, had severe underlying conditions and no prior vancomycin exposure.
• The isolated E. faecalis strains exhibited high-level resistance to vancomycin and teicoplanin.

Findings:

• The vancomycin-resistant E. faecalis strains were susceptible to daptomycin, offering a potential alternative treatment.
• No further instances of high-level glycopeptide-resistant enterococci were detected in the hospital for 23 months post-identification.
• This occurrence aligns with other reported instances of glycopeptide resistance in enterococci within Spanish hospitals.

Implications:

• The rise in penicillin and aminoglycoside resistance among enterococci necessitates careful consideration for clinical laboratories and therapeutic strategies.
• Monitoring antibiotic resistance patterns is crucial for effective management of enterococcal infections.
• The emergence of vancomycin resistance underscores the need for antimicrobial stewardship programs.