Enterococcus casseliflavus bacteremia: A report of two cases and review of the literature

Abstract

Intrinsically vancomycin-resistant Enterococci are rarely recovered from blood culture. These microorganisms usually exist in human gastrointestinal tract. Enterococci have an important role in serious invasive infections, including nosocomial infections, endocarditis, bacteremia, urinary tract infection, and pelvic infection. The clinical importance of intrinsically vancomycin-resistant enterococci is increasing day by day, because some of them are responsible for recurrent bacteremia in humans with malignancy and receipt of transplant history. Generally, intrinsic low-level vancomycin resistance (vanC type) is observed in E. casseliflavus and E. gallinarum species. However, E. gallinarum isolates which carried both the vanC1 and vanA genes were described in two research. In our study, we reviewed the medical records of two patients with E. casseliflavus bacteremia and investigated underlying diseases or conditions. Both patients had chronic renal failure and they were being treated in the hemodialysis unit at our hospital. When reproduction was detected in their blood culture, the patients were administered combination therapy including daptomycin+imipenem and daptomycin+cefepime during bacteremia periods. The patients’ condition improved within 72 hours with treatment. In conclusion, this study demonstrates that intrinsically vancomycin-resistant enterococci have the clinical significance in the treatment of in bacteremia developing on basis of a chronic illness or malignancy.