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Vancomycin-resistant Enterococcus faecium Empyema in an Asplenic Patient

Matthew J Cotton1, Clifford D Packer1

  • 1Internal Medicine, Case Western Reserve University School of Medicine, Cleveland, USA.

Cureus
|November 10, 2018
PubMed

Insights

A rare case of enterococcal empyema caused by vancomycin-resistant Enterococcus faecium (VRE) in an asplenic patient was successfully treated with linezolid. This highlights the need to consider VRE in complex pneumonia cases.

Area of Science:

  • Infectious Diseases
  • Pulmonology
  • Critical Care Medicine

Background:

  • Enterococcal empyema is an uncommon pulmonary complication.
  • Pneumonia can lead to severe respiratory failure and empyema.

Observation:

  • A 67-year-old asplenic male presented with pneumonia, respiratory failure, and empyema.
  • Empyema cultures were initially negative, later yielding vancomycin-resistant Enterococcus faecium (VRE).

Findings:

  • The patient required decortication and prolonged chest tube drainage.
  • Successful treatment was achieved with linezolid, an antibiotic effective against VRE.
  • This is the second reported case of VRE empyema without intra-abdominal source, suggesting airway or chest tube contamination.

Implications:

  • Physicians should consider multi-drug resistant organisms like VRE in refractory empyema cases.
  • Early identification and appropriate antibiotic selection are crucial for managing VRE empyema.
Keywords:
antimicrobialsantimicrobrial resistanceaspleniaclinical microbiologyempyemaenterococcienterocococcus faeciuminfectious diseasesvacomyocin resistant enterococcus faeciumvre

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