Successful treatment of Enterococcus gallinarum infection in a neonate with vancomycin: a case report.
Enterococcus gallinarum (EG)
Adverse reaction
Linezolid
Neonate
Vancomycin
Journal
BMC pediatrics
ISSN: 1471-2431
Titre abrégé: BMC Pediatr
Pays: England
ID NLM: 100967804
Informations de publication
Date de publication:
15 Aug 2024
15 Aug 2024
Historique:
received:
05
05
2024
accepted:
09
08
2024
medline:
16
8
2024
pubmed:
16
8
2024
entrez:
15
8
2024
Statut:
epublish
Résumé
Enterococcus gallinarum (EG) is typically found in the gastrointestinal tracts of birds and mammals. Although its strains are rarely isolated from clinical specimens, EG can lead to septicemia in immunocompromised individuals. EG infections are uncommon in household settings, but their incidence has been rising due to increased antibiotic usage and invasive treatments, particularly in Neonatal Intensive Care Units (NICUs). EG inherently exhibits resistance to vancomycin but is highly sensitive to linezolid. Despite showing in vitro resistance, vancomycin has shown clinical efficacy in treating EG meningitis. A neonate born at 30 + 2 weeks gestation was admitted to the Neonatal Intensive Care Unit (NICU) after EG was detected in blood and cerebrospinal fluid cultures. Susceptibility testing indicated that the bacterial strain was resistant to vancomycin and sensitive to linezolid. Initially, vancomycin was selected for treatment. However, due to persistent EG cultures in the blood and cerebrospinal fluid, the treatment was adjusted to linezolid. This led to a rapid decrease in platelet (PLT) count, suspected to be an adverse reaction. Concurrently, the patient experienced recurrent fever and elevated inflammatory marker levels, prompting the discontinuation of linezolid and a return to vancomycin. Subsequent administration of vancomycin stabilized the patient's condition, as evidenced by improved C-reactive protein (CRP), procalcitonin (PCT), and cerebrospinal fluid parameters, ultimately leading to discharge after an eight-week treatment period. This retrospective analysis highlights the efficacy of vancomycin in treating EG infections, suggesting that specific genetic phenotypes may influence treatment sensitivity. Monitoring vancomycin blood levels is crucial for determining treatment effectiveness.
Sections du résumé
BACKGROUND
BACKGROUND
Enterococcus gallinarum (EG) is typically found in the gastrointestinal tracts of birds and mammals. Although its strains are rarely isolated from clinical specimens, EG can lead to septicemia in immunocompromised individuals. EG infections are uncommon in household settings, but their incidence has been rising due to increased antibiotic usage and invasive treatments, particularly in Neonatal Intensive Care Units (NICUs). EG inherently exhibits resistance to vancomycin but is highly sensitive to linezolid. Despite showing in vitro resistance, vancomycin has shown clinical efficacy in treating EG meningitis.
CASE PRESENTATION
METHODS
A neonate born at 30 + 2 weeks gestation was admitted to the Neonatal Intensive Care Unit (NICU) after EG was detected in blood and cerebrospinal fluid cultures. Susceptibility testing indicated that the bacterial strain was resistant to vancomycin and sensitive to linezolid. Initially, vancomycin was selected for treatment. However, due to persistent EG cultures in the blood and cerebrospinal fluid, the treatment was adjusted to linezolid. This led to a rapid decrease in platelet (PLT) count, suspected to be an adverse reaction. Concurrently, the patient experienced recurrent fever and elevated inflammatory marker levels, prompting the discontinuation of linezolid and a return to vancomycin. Subsequent administration of vancomycin stabilized the patient's condition, as evidenced by improved C-reactive protein (CRP), procalcitonin (PCT), and cerebrospinal fluid parameters, ultimately leading to discharge after an eight-week treatment period.
CONCLUSION
CONCLUSIONS
This retrospective analysis highlights the efficacy of vancomycin in treating EG infections, suggesting that specific genetic phenotypes may influence treatment sensitivity. Monitoring vancomycin blood levels is crucial for determining treatment effectiveness.
Identifiants
pubmed: 39148024
doi: 10.1186/s12887-024-05004-6
pii: 10.1186/s12887-024-05004-6
doi:
Substances chimiques
Vancomycin
6Q205EH1VU
Anti-Bacterial Agents
0
Linezolid
ISQ9I6J12J
Types de publication
Journal Article
Case Reports
Langues
eng
Sous-ensembles de citation
IM
Pagination
527Informations de copyright
© 2024. The Author(s).
Références
Prakash VP, Rao SR, Parija SC. Emergence of unusual species of enterococci causing infections, South India. BMC Infect Dis. 2005;5:14. https://doi.org/10.1186/1471-2334-5-14 .
doi: 10.1186/1471-2334-5-14
pubmed: 15774018
pmcid: 555955
Li X, Fan S, Lin X, et al. The first case report of Enterococcus gallinarum meningitis in neonate: a literature review. Med (Baltim). 2018;97(7):e9875. https://doi.org/10.1097/MD.0000000000009875 .
doi: 10.1097/MD.0000000000009875
Monticelli J, Knezevich A, Luzzati R, Di Bella S. Clinical management of nonfaecium nonfaecalis Vancomycin-resistant enterococci infection. Focus on Enterococcus gallinarum and Enterococcus casseliflavus/flavescens. J Infect Chemother. 2018;24(4):237–46. https://doi.org/10.1016/j.jiac.2018.01.001 .
doi: 10.1016/j.jiac.2018.01.001
pubmed: 29396199
Chiappini E, Conti C, Galli L, de Martino M. Clinical efficacy and tolerability of linezolid in pediatric patients: a systematic review. Clin Ther. 2010;32(1):66–88. https://doi.org/10.1016/j.clinthera.2010.01.019 .
doi: 10.1016/j.clinthera.2010.01.019
pubmed: 20171414
Rao GG, Konicki R, Cattaneo D, et al. Therapeutic drug monitoring can improve Linezolid Dosing regimens in current clinical practice: a review of Linezolid Pharmacokinetics and Pharmacodynamics. Ther Drug Monit. 2020;42(1):83–92. https://doi.org/10.1097/FTD.0000000000000710 .
doi: 10.1097/FTD.0000000000000710
pubmed: 31652190
Ogami C, Tsuji Y, To H, Yamamoto Y. Pharmacokinetics, toxicity and clinical efficacy of linezolid in Japanese pediatric patients. J Infect Chemother. 2019;25(12):979–86. https://doi.org/10.1016/j.jiac.2019.05.025 .
doi: 10.1016/j.jiac.2019.05.025
pubmed: 31208925
Leclercq R, Dutka-Malen S, Duval J, Courvalin P. Vancomycin resistance gene vanC is specific to Enterococcus gallinarum. Antimicrob Agents Chemother. 1992;36(9):2005–8. https://doi.org/10.1128/AAC.36.9.2005 .
doi: 10.1128/AAC.36.9.2005
pubmed: 1416893
pmcid: 192426
Mulubwa M, Griesel HA, Mugabo P, Dippenaar R, van Wyk L. Assessment of Vancomycin Pharmacokinetics and Dose Regimen optimization in Preterm neonates. Drugs R D. 2020;20(2):105–13. https://doi.org/10.1007/s40268-020-00302-7 .
doi: 10.1007/s40268-020-00302-7
pubmed: 32266599
pmcid: 7221111
Sosnin N, Curtis N, Cranswick N, Chiletti R, Gwee A. Vancomycin is commonly underdosed in critically ill children and neonates. Br J Clin Pharmacol. 2019;85(11):2591–8. https://doi.org/10.1111/bcp.14084 .
doi: 10.1111/bcp.14084
pubmed: 31378957
pmcid: 6848905
He N, Su S, Ye Z, et al. Evidence-based Guideline for Therapeutic Drug Monitoring of Vancomycin: 2020 update by the Division of Therapeutic Drug Monitoring, Chinese Pharmacological Society. Clin Infect Dis. 2020;71(Suppl 4):S363–71. https://doi.org/10.1093/cid/ciaa1536 .
doi: 10.1093/cid/ciaa1536
pubmed: 33367582
Dao K, Guidi M, André P, et al. Optimization of Vancomycin exposure in neonates based on the best level of evidence. Pharmacol Res. 2020;154:104278. https://doi.org/10.1016/j.phrs.2019.104278 .
doi: 10.1016/j.phrs.2019.104278
pubmed: 31108184