Acute Cholecystitis Caused by Vancomycin-Resistant Enterococcus faecium in a Morbidly Obese Patient with Multiple Co-Morbidities

Abstract

Background: Vancomycin-resistant Enterococcus faecium (VRE) is a low virulent pathogen. It can cause a variety of infections most commonly in immunosuppressed patients and those with previous exposure to broad-spectrum antibiotics. Case Presentation: A morbidly obese male with multiple comorbidities presented with acute cholecystitis. Because of the high operative risk it was decided to treat the condition with antibiotics and ultrasound-guided percutaneous cholecystostomy tube placement. Cultures of bile revealed VRE and initial therapy consisted of daptomycin. Cultures on day seven after initiation of daptomycin showed continuing growth of VRE and therapy was changed to linezolid and the patient was able to clear VRE from bile and cholecystitis resolved. The tube was removed after six months and interval cholecystectomy was planned after appropriate weight loss. Conclusion(s): We report the first case of VRE acute cholecystitis in North America. Only two additional cases have been reported thus far, both from Italy. One responded to daptomycin, which is in contrast to our experience. However, similar to the other reported case, our patient had a good response to linezolid, which may be the preferred agent to treat this condition.Copyright © 2016 Hugo Bonatti et al.