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Recovery of resistant enterococci during vancomycin prophylaxis
A H Kaplan1, P H Gilligan, R R Facklam
1Department of Pediatrics and Medicine, University of North Carolina School of Medicine, Chapel Hill 27514.
Abstract:
We report a case of a patient undergoing hemodialysis who developed a wound infection and subsequently bacteremia with a strain of vancomycin-resistant enterococcus identified as Enterococcus gallinarum. He had been receiving vancomycin prophylaxis before developing these infections. Both isolates were susceptible to ampicillin, rifampin, teicoplanin, and daptomycin (LY146032).
Insights
A hemodialysis patient developed vancomycin-resistant Enterococcus gallinarum infections despite vancomycin prophylaxis. This highlights treatment challenges and potential resistance in vulnerable patient populations.
Area of Science:
- Infectious Diseases
- Nephrology
- Microbiology
Background:
- Patients undergoing hemodialysis are at increased risk for infections.
- Vancomycin is commonly used for prophylaxis and treatment in this population.
- Emergence of antimicrobial resistance is a significant clinical concern.
Observation:
- A patient on hemodialysis developed a wound infection.
- The infection progressed to bacteremia (bacteria in the bloodstream).
- The causative agent was identified as vancomycin-resistant Enterococcus gallinarum.
Findings:
- The vancomycin-resistant Enterococcus gallinarum strain was identified.
- The patient had been receiving vancomycin prophylaxis prior to infection.
- Isolates were susceptible to ampicillin, rifampin, teicoplanin, and daptomycin.
Implications:
- This case underscores the challenge of vancomycin resistance in hemodialysis patients.
- Alternative antibiotic strategies may be necessary for prophylaxis and treatment.
- Further research into resistance mechanisms and effective therapies is warranted.