Journal of Infectious Diseases & Therapy
Open Access

Abstract

Enterococci have become common nosocomial pathogens and are currently the third-leading causes of nosocomial bloodstream infection. Vancomycin-Resistant Enterocolli (VRE), mostly Enterococcus faecium, are increasingly involve, especially in critical patients with co-morbid condition. The options for treatment of VRE have improved over the years with the advent of oxazolidinone linezolid, the glycylcycline tigecycline and the lipopeptide daptomycin. Nonetheless, toxicities my limit their use. We here report a case of VRE prosthetic valve endocarditis with daptomycin due to severe lactic acidosis complicated by Linezolid. A 45 years old female, who had undergone prosthetic aortic valve replacement 15 years back, is presented with cardiogenic shock. Chest X-ray showed pulmonary edema. Pannus formation on a Hancock II 21 mm aortic valve prosthetis in the aortic position as depicted by transthoracic echocardiogram. Oliguria was developed and eGFR was rise. She underwent continuous renal replacement therapy. Until waiting redo aortic valve replacement, abruptly fever was developed. Transthoracic echocardiography showed vegetation at tricuspid valve. Urgent aortic valve replacement was done without complication. Blood cultures grew Enterocuccus faecium, which was resistant to vancomycin but susceptible to linezolid and daptomycin. However, tissue cultures showed no growth results. Treatment with intravenous Linezolid was initiated. Her bacteremia initially cleared. After 16 days on treatment of linezolid, lactic acid was elevated up to 15 mmol/L. We switched linezolid to daptomycin. Lactic acid was decreased to normal range after 8 days stopping linezolid. Severe lactic acidosis with linezolid present barriers to effective treatment. Serial follow up of lactic acid during treatment with Linezolid is crucial to management patients with VRE.

Biography

Soo Youn Lee has completed her Doctor of Medicine from Chosun University College of Medicine. She is the Director of ICU at Sejong General Hospital, Buchoen, Republic of Korea. She has published 6 papers in reputed journals.

E-mail: leesy@sejongh.co.kr