Sepsis secondary to multifocal Enterococcus faecium infection: A case report

• Published in: Medicine (Baltimore) 2020-07, Vol.99 (27), p.e19811-e19811
• Main Authors: Huang, Xiao-qing, Qiu, Jun-ke, Wang, Cai-hong, Pan, Lei, Xu, Jie-kun, Pan, Xiao-hong, Ji, Xiao-bo, Mao, Min-jie
• Format: Article
• Language: English
• Subjects: Aged; Anti-Bacterial Agents - therapeutic use; Clinical Case Report; Diagnosis, Differential; Enterococcus faecium - isolation & purification; Female; Gram-Positive Bacterial Infections - complications; Gram-Positive Bacterial Infections - diagnosis; Gram-Positive Bacterial Infections - drug therapy; Humans; Sepsis - drug therapy; Sepsis - microbiology; Tuberculosis, Pulmonary - diagnosis
• ISSN: 0025-7974; 1536-5964
• DOI: 10.1097/MD.0000000000019811

Nosocomial Enterococcus faecium (E faecium) infections are common among immunocompromised patients; however, sepsis caused by E faecium is rarely encountered in the clinical setting. A 69-year-old woman with a previous history of tuberculosis (TB), developed symptoms of recurrent fever, paroxysmal cough, and exertional dyspnea for over 2 months before she presented to the hospital. The patient was initially misdiagnosed with recurrent TB, and did not respond to anti-TB therapy. Culture results of blood, endotracheal necrotic tissue, and urine confirmed a diagnosis of multifocal E faecium infection. On definitive diagnosis, the patient received intensive antimicrobial combination treatment with linezolid, teicoplanin, caspofungin, and voriconazole on the basis of antimicrobial susceptibility results. After transient improvement, the patient's condition deteriorated due to secondary infections, and the patient died after discharge against medical advice. E faecium bacteremia may cause sepsis in immunocompromised patients, and has a high mortality rate. Careful pathogen detection and early initiation of treatment is crucial to good patient outcome.