VANCOMYCIN RESISTANT ENTEROCOCCUS FAECALIS CAUSING DIARRHEA IN RENAL TRANSPLANT PATIENT

Ranjit Sah, Shusila Khadka, Dibya Singh Shah, Mahesh Adhikari, Neha Shrestha, Hari Prasad Kattel, Sangita Sharma, Shyam Kumar Mishra, Keshab Parajuli, Jeevan Bahadur Sherchand, Niranjan Prasad Shah, Bharat Mani Pokharel, Basista Rijal

Abstract


Enterococcus faecalis is a commensal organism of the intestinal tract. However, it may be a causative agent of diarrhea in elderly and immunocompromised patients. Here we report a case of a 33 years female who presented with diarrhea few days after her renal transplant. She was on corticosteroids, cotrimoxazole, valcyclovir, ceftriaxone and metronidazole. However, she was having diarrhea for 12 days. Three consecutive stool sample was processed for culture on MacConkey agar which revealed Enterococcus faecalis as the predominant organism. The organism was identified on the basis of biochemical tests.  Enterococcus faecalis which was isolated in her stool sample was resistant to most of the antibiotics including vancomycin, however it was sensitive to linezolid. The resistance of the isolate to vancomycin was confirmed by minimum inhibitory concentration (MIC) testing by agar dilution method which showed that MIC was more than 16 mcg/ml. On the background of immunosuppressive state of the patient, predominant colony of E. faecalis on repeated culture, negative test for toxin analysis for C. difficile and improvement of the patient on third day of linezolid therapy, vancomycin resistance Enterococcus faecalis was considered the causative agent of her diarrhea. Stool culture on the third day of linezolid and on follow up after seven days revealed no growth of Enterococcus species. Vancomycin-resistant Enterococci are organisms renowned for their ability to cause infections with limited treatment options and may cause diarrhea in immunocompromised patients. So, diarrhea not responding to commonly used antimicrobial agent should be searched for vancomycin-resistance Enterococci for proper management of the patient.

Keywords


Vancomycin Resistance Enterococci, Renal transplant, diarrhea, immunocompromised, Nepal

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