VanA Mediated Glycopeptide Resistant Enterococcus faecium (GRE) Infection in an Elderly Patient with Chronic Kidney Disease – A Case Report DD03-DD05
Dr. Martin Jane Esther,
C4, 10 B Cross, Thillai Nagar, Trichy-620018, Tamil Nadu, India.
A 66-year-old male patient who is a known case of chronic kidney disease was admitted to the hospital with complaint of seizures. He was uremic and showed signs of encephalopathy. He was previously hospitalized frequently and was on antitubercular treatment. A left sided radio cephalic fistula was made and the patient was on dialysis. Urinary catheter and central venous catheter were placed. Urine and blood cultures showed growth of Enterococcus faecium which was resistant to vancomycin – Vancomycin Resistant Enterococci (VRE) or Glycopeptide Resistant Enterococci (GRE) by antibiotic susceptibility testing. The isolate was genotyped for detection of Van A, Van B and Van C genes and was found to harbour Van A gene. The treatment details of the patient and his outcome have been described. As Enterococci are inherently resistant to many drugs, their treatment is quite challenging. Combination therapy and de-escalation from broad spectrum antimicrobials to specific narrow spectrum antibiotics immediately after antibiotic sensitivity report is available which prevents emergence of drug resistance. Spread of VRE infection must be controlled by strict infection control methods as plasmid mediated rapid transfer of VRE can occur to other organisms like Staphylococci which is a serious threat.