PDF(Pubmed)
Abstract：
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.
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.
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.
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.
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.
摘要：
背景：鸡肠球菌（EG）通常存在于鸟类和哺乳动物的胃肠道中。尽管它的菌株很少从临床标本中分离出来，EG可导致免疫受损个体的败血症。EG感染在家庭环境中并不常见，但是由于抗生素使用和侵入性治疗的增加，它们的发病率一直在上升，特别是在新生儿重症监护病房（NICU）。EG固有地表现出对万古霉素的抗性,但对利奈唑胺高度敏感。尽管显示了体外抗性，万古霉素已显示出治疗EG脑膜炎的临床疗效。
方法：在血液和脑脊液培养中检测到EG后，将妊娠30+2周出生的新生儿送入新生儿重症监护病房（NICU）。药敏试验表明，该菌株对万古霉素耐药，对利奈唑胺敏感。最初，选择万古霉素进行治疗。然而,由于血液和脑脊液中持续的EG培养物，治疗调整为利奈唑胺.这导致血小板（PLT）计数迅速减少，怀疑是不良反应。同时,患者出现反复发热和炎症标志物水平升高,提示停止利奈唑胺和恢复万古霉素。随后服用万古霉素稳定了患者的病情，正如C反应蛋白（CRP）改善所证明的那样，降钙素原(PCT),和脑脊液参数，最终导致8周治疗后出院。
结论：本回顾性分析强调了万古霉素治疗EG感染的疗效，提示特定的遗传表型可能影响治疗敏感性。监测万古霉素血液水平对于确定治疗效果至关重要。
方法：在血液和脑脊液培养中检测到EG后，将妊娠30+2周出生的新生儿送入新生儿重症监护病房（NICU）。药敏试验表明，该菌株对万古霉素耐药，对利奈唑胺敏感。最初，选择万古霉素进行治疗。然而,由于血液和脑脊液中持续的EG培养物，治疗调整为利奈唑胺.这导致血小板（PLT）计数迅速减少，怀疑是不良反应。同时,患者出现反复发热和炎症标志物水平升高,提示停止利奈唑胺和恢复万古霉素。随后服用万古霉素稳定了患者的病情，正如C反应蛋白（CRP）改善所证明的那样，降钙素原(PCT),和脑脊液参数，最终导致8周治疗后出院。
结论：本回顾性分析强调了万古霉素治疗EG感染的疗效，提示特定的遗传表型可能影响治疗敏感性。监测万古霉素血液水平对于确定治疗效果至关重要。
