A rare case of pleuropulmonary infection and septic shock associated with Enterococcus faecium endocarditis

MacEachern, Paul; Giannoccaro, J. Peter; Elsayed, Sameer; Read, Ronald R.; Laupland, Kevin B.

doi:10.1016/j.jinf.2003.11.005

Cited by 10 publications

(10 citation statements)

References 7 publications

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“…We conducted a literature search based on PubMed in an attempt to identify all published cases of pleuropulmonary infection due to enterococcus, without time limits. Twenty-four cases of Enterococcus-associated pleuropulmonary infection previously published in the literature were eventually summarized in Table 1 [6,[9][10][11][12][13][14][15][16][17][18][19][20][21][22][23][24][25][26]. The enterococcal pneumonia cases previously described in the literature mainly occurred in elderly patients with immunosuppression, organ transplantation, hematological malignancies, solid cancer, renal failure, cardiocerebrovascular disease and chronic obstructive pulmonary disease.…”

Section: Discussionmentioning

confidence: 99%

Vancomycin-resistant Enterococcus faecium pneumonia in a uremic patient on hemodialysis: a case report and review of the literature

Wang

Sun

et al. 2020

BMC Infect Dis

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Background: Even though enterococci can cause serious infections in multiple sites, they are a rare cause of pneumonia. We reported a uremic patient with vancomycin-resistant E. faecium (VRE-fm) pneumonia, possibly related to epileptic seizures. Case presentation: A 57-year old man with uremia on hemodialysis was admitted to the hospital with complaint of recurrent epileptic seizures, followed by a two-week history of recurrent fever and cough with purulent sputum. Chest CT demonstrated multiple exudation of both lungs. He was diagnosed as community acquired pneumonia. Despite antibiotic combination therapy, abnormal chest shadows aggravated. Sputum and blood cultures were initially negative, but later blood culture grew VRE-fm. We suspected aspiration of gastrointestinal content induced by epilepsy as the most likely mechanism. The patient was successfully treated with a four-week course of linezolid according to the antibiotic susceptibility testing. Conclusions: Physicians should consider multi-drug resistant organisms such as VRE in uremic patients with pneumonia that fails to resolve with broad-spectrum antibiotics, especially in the cases with aspiration induced by epilepsy, immunocompromised conditions, and repeated or prolonged hospitalizations.

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Section: Discussionmentioning

confidence: 99%

Vancomycin-resistant Enterococcus faecium pneumonia in a uremic patient on hemodialysis: a case report and review of the literature

Wang

Sun

et al. 2020

BMC Infect Dis

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“…Maschmeyer et al [19] defined the isolation of these microorganisms from BAL fluid as etiologically insignificant findings for lung infiltrates. However, there are some authors suggesting that immunocompromised patients may develop pneumonia from these microorganisms [7,17,28].…”

Section: Discussionmentioning

confidence: 99%

Therapeutic implication of BAL in patients with neutropenia

Kuehnhardt

Hannemann²,

Schmidt³

et al. 2009

Ann Hematol

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Bronchoalveolar lavage (BAL) is a practicable procedure establishing the etiology of pneumonia. In patients with neutropenia, empirical antimicrobial treatment is mandatory immediately after diagnosis of infection, usually before results of BAL are available. We evaluated the impact of BAL on treatment and outcome of pneumonia in immunocompromised patients with a special regard to neutropenia. Bronchoscopy with BAL was performed in 58 episodes of clinical documented pneumonia in patients with hematological malignancies (88%) or solid tumors (12%), in 30 cases patients had neutropenia, in 28 cases patients had no neutropenia. In 93% of cases, BAL was performed under empirical antimicrobial treatment. BAL fluid was cultivated for bacteria, fungi, and tested for Pneumocystis jirovecii and cytomegalovirus (CMV). BAL revealed positive bacterial results in 67% of cases. Gram-positive microorganisms were detected in 95% of positive BAL results, gram-negative microorganisms in 23%, mixed bacterial cultures occurred in 41%. Positive fungi cultures were found in 59%. P. jirovecii was detected in 5% of cases tested and CMV in 8%. There was no significant difference between neutropenic and non-neutropenic patients. BAL results directed a change of therapy in only six of 58 episodes (5%). Overall mortality related to pneumonia was 16%. In this patient setting, the yield of BAL rarely has a significant influence on treatment and outcome of pneumonia. The early beginning of antimicrobial treatment reduces the diagnostic yield of BAL. In patients with pneumonia during neutropenia, its use should be well considered.

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“…They are facultative anaerobes and rarely cause empyema [3], but have been described causing infection of the abdomen, heart and kidneys [3]. However, they usually cause bloodstream [4] and urinary tract infections [5].…”

Section: Discussionmentioning

confidence: 99%

Pleural Enterococcus faecalis Empyema: An Unusual Case

et al. 2007

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A 63-year-old female patient was admitted to the department of neurology following an acute ischemic infarction of the right medial cerebral artery. She developed fever, respiratory failure, and hypotension and had to be transferred to the intensive care unit (ICU) for intubation and mechanical ventilation. Chest X-ray showed increased density of the complete right hemi-thorax, indicative of massive pleural effusion. Chest tube drainage produced 1.5 l of pus in 1 h. Cultures revealed growth of Enterococcus faecalis. The patient was treated with amoxicillin and clavulanic acid with good clinical response. Enterococci very rarely cause spontaneous pleural empyema. The natural resistance of enterococci to several types of antibiotics can lead to selection of enterococci as seen in other clinical studies and may lead to this unusual clinical consequence.

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A rare case of pleuropulmonary infection and septic shock associated with Enterococcus faecium endocarditis

Cited by 10 publications

References 7 publications

Vancomycin-resistant Enterococcus faecium pneumonia in a uremic patient on hemodialysis: a case report and review of the literature

Vancomycin-resistant Enterococcus faecium pneumonia in a uremic patient on hemodialysis: a case report and review of the literature

Therapeutic implication of BAL in patients with neutropenia

Pleural Enterococcus faecalis Empyema: An Unusual Case

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