Bacteremia Due to Vancomycin-Dependent Enterococcus faecium

A recipient of small-bowel and liver transplants developed recurrent fever and polymicrobial bacteremia due to multiply resistant Enterobacter cloacae and an inducible VanB strain of Enterococcus faecium while receiving therapy with amikacin, imipenem, and vancomycin. These organisms could not be su...

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Bibliographic Details
Published in:Clinical infectious diseases 1995-03, Vol.20 (3), p.712-714
Main Authors: Green, Michael, Shlaes, Janet H., Barbadora, Karen, Shlaes, David M.
Format: Article
Language:English
Subjects:
Bacteremia
Bacteremia - microbiology
Bacterial diseases
Bacterial sepsis
Biological and medical sciences
Blood
Child, Preschool
Enterococcus faecium
Enterococcus faecium - drug effects
Epiphyses
Female
Fever
Gram-Positive Bacterial Infections - microbiology
Human bacterial diseases
Humans
Infections
Infectious diseases
Liver Transplantation
Medical sciences
Vancomycin - pharmacology
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Summary:A recipient of small-bowel and liver transplants developed recurrent fever and polymicrobial bacteremia due to multiply resistant Enterobacter cloacae and an inducible VanB strain of Enterococcus faecium while receiving therapy with amikacin, imipenem, and vancomycin. These organisms could not be subcultured onto blood agar but did grow around the vancomycin disk on a direct-susceptibility test plate. Additional testing confirmed the strain as E. faecium, which would not grow in the absence of vancomycin. Growth around a disk containing d-alanyl-d-alanine was demonstrated. Spontaneous vancomycin-independent revertants were obtained at a frequency of ∼ 1 × 10−6. Two classes of vancomycin-independent revertants were obtained: one that was constitutively vancomycin resistant and one that was nonconstitutively vancomycin resistant. We hypothesize that the normal d-ala ligase is not expressed in the vancomycin-dependent strain; thus survival of these strains is dependent on expression of the VanB ligase, which produces a depsipeptide precursor that is resistant to vancomycin binding. This is the second reported case involving a clinically important vancomycin-dependent enterococcal strain. Awareness of the existence of these strains is important, especially when clinical and microbiological data are consistent with infection due to a fastidious or nutritionally-deficient organism.
ISSN:1058-4838
1537-6591
DOI:10.1093/clinids/20.3.712