Multidrug‐resistantEnterococcus faeciumin a Patient with Burns

Enterococcus species represent an important nosocomial pathogen. In the United States between 1992 and 1999, intensive care unit-associated enterococcal infections accounted for 13.5% of primary bloodstream infections, 1.7% of pneumonia infections, and 13.8% of urinary tract infections [1]. In recent years, concern has been expressed regarding the increase in antimicrobial resistance among enterococci [2, 3]. Enterococci are intrinsically resistant to many antibiotics, including the cephalosporins, semisynthetic penicillins, and aminoglycosides. Acquired resistance to penicillins, macrolides, fluoroquinolones, and vancomycin has been frequently described. Two newer agents, linezolid and quinupristin/dalfopristin, have been demonstrated to have activity against Enterococcus species resistant to other drug classes [4–5]. We describe a patient with extensive burns who developed infection with a strain of Enterococcus faecium resistant to multiple drugs, including vancomycin, ampicillin, and gentamicin, as well as linezolid and quinupristin/dalfopristin. The patient, a 34-year-old man, was hospitalized on 20 January 2002 for treatment of burns covering 40% of his body surface area and inhalation injury caused by a house fire. During his hospitalization, the patient required therapy for multiple infections including the following: 3 episodes of bacteremia with Serratia marcescens; 4 episodes of pneumonia with Streptococcus pneumoniae, methicillin-resistant Staphylococcus aureus and Gram-negative bacilli, Stenotrophomonas maltophilia, and S. marcescens; a biliary infection with mixed flora; a cutaneous colonization/infection with Aspergillus fumigatus; and 3 episodes of catheter colonization/infection with Acinetobacter species, S. marcescens, and Pseudomonas aeruginosa. Prior to 24 March 2002, the patient received multiple antibiotics including vancomycin, amphotericin B, imipenem, tobramycin, ciprofloxacin, linezolid, piperacillin-tazobactam, and quinupristin/dalfopristin.