Sepsis secondary to postoperative Enterococcus gallinarum infection in a patient with rectal cancer: A case report

Enterococcus gallinarum, while of relatively low virulence, is an emerging multidrug-resistant opportunistic pathogen. This case report aims to highlight the diagnostic and therapeutic challenges posed by this organism, particularly in immunocompromised hosts following major surgery, and to emphasize the importance of early microbiological identification and targeted therapy in such scenarios.

A 55-year-old woman was admitted to our hospital with a 1-month history of recurrent abdominal pain and bloating. She underwent surgical intervention and subsequently developed septic shock. Despite empiric therapy with imipenem-cilastatin (1000 mg every 8 hours) plus vancomycin (1000 mg every 12 hours), her condition deteriorated, presenting with persistent fever and progressive multiorgan dysfunction syndrome.

Enterococcus gallinarum (Group D), intrinsically resistant to vancomycin, was isolated from the wound secretion culture.

According to the culture results, antibiotic therapy was adjusted to levofloxacin (300 mg once daily) plus meropenem (1000 mg every 8 hours).

After the adjustment of antibiotics, the patient's body temperature normalized within days. Following 1 week of targeted antibiotic therapy, all infection markers (including white blood cell count and procalcitonin) normalized. The antibiotic regimen was successfully de-escalated, and the patient was discharged after full clinical recovery.

The diagnosis and management of sepsis due to postoperative E gallinarum infection should focus on preventing and controlling postoperative complications, performing early etiological cultures, and selecting appropriate antibiotics.