A54-13 Enterococcus Faecalis With Strongylosis's Ventriculitis, Coconspirators or Coincidence?

Le résumé fourni par la source

Abstract Background Enterococcus faecalis is a gram positive bacterium normally found in the digestive tract, recognized for difficult to treat infections post neurosurgical intervention and placement of surgical hardware. It is associated with greater than 5%-14% mortality when found due to antibiotic resistance, formation of biofilm, and difficulty crossing the blood brain barrier. It has also been associated with Strogyloides, a nematode parasite endemic to the Southeastern United states typically infecting the lungs and gastrointestinal tract. Although the Infectious Disease Society of America (IDSA) has placed guidelines and a framework for the treatment of E. Faecalis, it is unclear how coinfection should change treatment. Case Presentation We present the case of a 54-year-old female with no past medical history who was brought to the ER for an unwitnessed ground level fall after being found by her family, with left-sided hemiparesis of unknown duration. Labs revealed eosinophilia, microcytic anemia and mild hypokalemia. Non-Contrast CT of the brain revealed a large right basal ganglia hemorrhage with intraventricular hemorrhage, a 7 mm leftward midline shift. The patient underwent emergent External Ventricular Drain (EVD) placement followed by admission to the intensive care unit (ICU). On day 16, she experienced fevers as high as 38.9 °C, prompting cerebrospinal fluid (CSF) cultures via EVD, which grew pan-sensitive E. feacalis, raising concern for probable nosocomial Enterococcus faecalis ventriculitis (EV). Brain MRI was inconclusive for ventriculitis. Strongyloides antibody levels were obtained to evaluate alternative causes for a E. faecalis CNS infection. The antibody levels returned elevated, so she was started on ivermectin. On day 32, repeat blood cultures grew vancomycin resistant Enterococcus faecium. She was treated with steroids for elevated intracranial pressures and septic shock respectively. Regarding the EV, the patient was initially started on day 16 on iv vancomycin and meropenem empirically which was changed following identification on day 18 to iv ampicillin-sulbactam 3g every 6 hours, ceftriaxone 2g every 12 hours and gentamicin. Family refused intrathecal antibiotics. She eventually died on day 45 due to respiratory failure and septic shock. Discussion A literature review by Cosimi et al in 2023 identified 21 similar cases, 12 succumbed to infection representing a greater than 50% mortality rate, much higher than isolated E. Faecalis ventriculitis with 14% mortality rate. Future focus should be directed at exposing either the incidental nature of these findings, or increased risk for mortality. This abstract is funded by: NONE

Ce résumé expose les affirmations des auteurs. BNTIC ne l’interprète pas comme une validation indépendante des résultats.