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Bacteremia due to vancomycin-dependent Enterococcus faecium

M Green1, J H Shlaes, K Barbadora

  • 1University of Pittsburgh, Pennsylvania, USA.

Clinical Infectious Diseases : an Official Publication of the Infectious Diseases Society of America
|March 1, 1995
PubMed
Summary

A rare vancomycin-dependent Enterococcus faecium strain emerged in a transplant patient. This vancomycin-dependent organism requires vancomycin for growth, highlighting a unique challenge in treating resistant infections.

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Area of Science:

  • Microbiology
  • Infectious Diseases
  • Transplant Medicine

Background:

  • A transplant recipient developed recurrent bacteremia while on broad-spectrum antibiotics.
  • The patient had infections with multidrug-resistant Enterobacter cloacae and a vancomycin-dependent Enterococcus faecium.

Purpose of the Study:

  • To characterize a novel vancomycin-dependent Enterococcus faecium strain.
  • To understand the mechanism of vancomycin dependence in this clinical isolate.

Main Methods:

  • Direct antibiotic susceptibility testing.
  • Growth studies in the presence and absence of vancomycin.
  • Isolation and characterization of vancomycin-independent revertants.
  • Analysis of cell wall precursor synthesis.

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Main Results:

  • The Enterococcus faecium strain exhibited vancomycin dependence, requiring vancomycin for growth.
  • The organism produced a depsipeptide precursor, suggesting VanB ligase activity.
  • Vancomycin-independent revertants were obtained, showing constitutive or non-constitutive resistance.

Conclusions:

  • Vancomycin-dependent Enterococcus faecium strains can emerge during vancomycin therapy.
  • These strains present diagnostic challenges due to their fastidious growth requirements.
  • Awareness of vancomycin-dependent organisms is crucial for appropriate clinical management and microbiological diagnosis.