VANCOMYCIN-RESISTANT ENTEROCOCCUS FAECIUM COLONIZATION AND CLOSTRIDIUM DIFFICILE INFECTION IN A HEMATOLOGIC PATIENT/KOLONIZACIJA VANKOMICIN REZISTENTNOM BAKTERIJOM ENTEROCOCCUS FAECIUM I CLOSTRIDIUM DIFFICILE INFEKCIJA U HEMATOLOSKE BOLESNICE

Vancomycin-resistant enterococci (VRE), especially Enterococcus faecium, have emerged as significant nosocomial pathogens and patients with impaired host defenses are at a particular risk of VRE infection. The most common occurrence is asymptomatic colonization of the gastrointestinal tract that can...

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Published inActa clinica Croatica (Tisak) Vol. 59; no. 3; p. 523
Main Authors Goic-Barisic, Ivana, Radic, Marina, Novak, Anita, Rubic, Zana, Boban, Natasa, Luksic, Boris, Tonkic, Marija
Format Journal Article
LanguageEnglish
Published Klinicki bolnicki centar Sestre milosrdnice 01.09.2020
Subjects
Blood diseases
Clostridium infections
Complications and side effects
Drug resistance in microorganisms
Enterococcal infections
Risk factors
Testing
Croatia
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Summary:Vancomycin-resistant enterococci (VRE), especially Enterococcus faecium, have emerged as significant nosocomial pathogens and patients with impaired host defenses are at a particular risk of VRE infection. The most common occurrence is asymptomatic colonization of the gastrointestinal tract that can persist for a long time and serve as a reservoir for transmission of VRE to other patients. We present a case of a patient who was diagnosed with acute myelogenous leukemia and suffered from bone marrow aplasia following induction therapy. The patient received prolonged broad-spectrum antimicrobial therapy. During hospital stay, the patient developed Clostridium difficile infection (CDI) and was found to be colonized with a strain of Enterococcus faecium resistant to vancomycin during therapy for CDI. This case also highlights the role of risk factors that could contribute to development of resistance, particularly CDI. Early detection of VRE colonization or infection is a crucial component in hospital program designed to prevent transmission of nosocomial infections. Surveillance cultures of such patients should be mandatory. Key words: Acute myelogenous leukemia; Clostridium difficile; Enterococcus faecium; Vancomycin-resistant enterococcus Vankomicin-rezistentni enterokoki (VRE), narocito Enterococcus faecium, spadaju medu najznacajnije bolnicke patogene, pri cemu su narocito ugrozeni bolesnici oslabljenog imunosnog statusa. Pritom je najcesca pojava asimptomatske kolonizacije probavnog sustava koja moze ustrajati duze vremena i biti rezervoar za sirenje VRE na ostale bolesnike. Donosimo prikaz slucaja bolesnice s dijagnozom akutne mijelomonocitne leukemije pracene aplazijom kostane srzi nakon indukcijske terapije. Bolesnica je lijecena antibioticima sirokog spektra. Tijekom hospitalizacije u bolesnice se razvila infekcija bakterijom Clostri-dium difficile (CDI) uz dokazanu kolonizaciju sojem Enterococcus faecium rezistentnog na vankomicin tijekom terapije zbog CDI. Takoder su prikazani cimbenici rizika koji su u navedenom slucaju mogli posluziti kao potencijalni okidac za razvoj rezistencije, s osobitim naglaskom na CDI. Rano otkrivanje kolonizacije ili infekcije navedenim sojevima je iznimno znacajan cimbenik bolnickog programa za prevenciju sirenja bolnickih infekcija. Mikrobioloski nadzor uzimanjem nadzornih kultura mora biti obvezni dio protokola pri hospitalizaciji takvih bolesnika. Kljucne rijeci: Akutna mijelomonocitna leukemija; Clostridium difficile; Enterococcus faecium; Vankomicin-rezistentni enterokok
ISSN:0353-9466
1333-9451
DOI:10.20471/acc.2020.59.03.17