Spontaneous bacterial peritonitis with sepsis caused by Enterococcus hirae

Area of Science:

• Infectious Diseases
• Gastroenterology
• Microbiology

Background:

• Selective intestinal decontamination (SID) using norfloxacin is common for preventing spontaneous bacterial peritonitis (SBP) recurrence in cirrhotic patients.
• However, SID can promote the development of antibiotic-resistant gut flora, potentially leading to infections by unusual pathogens.
• Enterococcus hirae, typically an animal pathogen, is rarely implicated in human infections.

Observation:

• A cirrhotic patient with a history of norfloxacin treatment for Klebsiella pneumoniae-induced SBP presented with septic shock.
• The patient developed SBP caused by Enterococcus hirae, a pathogen rarely seen in humans.

Findings:

• This case represents the first documented instance of spontaneous bacterial peritonitis caused by Enterococcus hirae.
• The infection occurred in a patient who had undergone prior prophylactic selective intestinal decontamination with norfloxacin.

Implications:

• The emergence of Enterococcus hirae as a pathogen in SBP underscores the potential for unusual bacterial infections following antibiotic prophylaxis.
• Clinicians should consider a broader spectrum of pathogens, including resistant strains and less common bacteria, in cirrhotic patients with SBP, especially after antibiotic exposure.
• This case highlights the need for vigilance regarding antibiotic resistance patterns in the context of SBP prophylaxis.