Endocarditis Due to Vancomycin-Resistant Enterococccus gallinarum in a Patient with End-Stage Renal Failure: A Case Report


The first described vancomycin resistant enterococci (VRE) was about twenty years ago. Recently VRE have been reported by many clinics. However endocarditis due to VRE is still a rare entity and there are only a few cases reported in the literature. We are reporting a 59-year-old male patient with chronic renal failure who was on hemodialysis. He presented with a sudden onset of fever, tachycardia and respiratory distress. The performed echocardiography revealed vegetations on the mitral and aortic valves. As he was diagnosed to have infective endocarditis the patient was put on ampicillin and gentamicin therapy. He underwent an emergent mitral and aortic valve surgery due to ensued heart failure. While he was still on ampicillin and gentamicin therapy, E. gallinarum, which was resistant to vancomycin (MIC = 8 mg/L), was isolated from the surgical valve specimens and hence his antibiotic regime was switched to teicoplanin (MIC < 0.5 mg/L). 28 days after teicoplanin therapy the patient was discharged with free of symptoms and any complication. This patient is presented as an example for an endocarditis with an unusual type of enterococci.

Share and Cite:

G. Ersoz, M. Uguz, B. N. Aytacoglu and A. Kaya, "Endocarditis Due to Vancomycin-Resistant Enterococccus gallinarum in a Patient with End-Stage Renal Failure: A Case Report," Advances in Infectious Diseases, Vol. 2 No. 1, 2012, pp. 9-12. doi: 10.4236/aid.2012.21002.

Conflicts of Interest

The authors declare no conflicts of interest.


[1] W. C. Huskins, M. C. Huckabee, P. N. O’Grady, P. Murray, H. Kopetskie, L. Zimmer, M. E. Walker, R. L. Sinkowitz-Cochran, J. A. Jernigan, M. Samore, D. Wallace and D. A. Goldmann, “Investigators Intervention to Reduce Transmission of Resistant Bacteria in Intensive Care,” New England Journal of Medicine, Vol. 364, No. 15, 2011, pp. 1407-1418.
[2] K. Dogson, “VRE Detection: A New Gold Standard,” Clinical Microbiology Newsletter, Vol. 26 No. 4, 2004, pp. 25-30.
[3] R. McDonald, L. Olaison, D. J. Anderson, B. Hoen, J. M. Miro, S. Eykyn, E. Abrutyn, V. G. Fowler Jr., G. Habib, C. Selton-Suty, P. A. Pappas, C. H. Cabell, G. R. Corey, F. Marco and D. J. Sexton “Enterococcal Endocarditis: 107 Cases from the International Collaboration on Endocarditis Merged Database” American Journal of Medicine, Vol. 118, No. 7, 2005, pp. 759-766.
[4] K. C. Reid, III F. R. Cockerill and R. Patel “Clinical and Epidemiological Features of Enterococcus casseliflavus/flavescens and Enterococcus gallinarum Bacteremia: A Report of 20 Cases” Clinical Infectious Diseases, Vol. 32, No. 11, 2001, pp. 1540-1546.
[5] S. Dargere, M. Vergnaud, R. Verdon, E. Saloux, O. Le Page, R. Leclercq and C. Bazin, “Enterococcus gallinarum Endocarditis Occurring on Native Heart Valves” Journal of Clinical Microbiology, Vol. 40, No. 6, 2002, pp. 2308-2310.
[6] M. Ortu, E. Gabrielli, I. Caramma, R. Rossotti, M. Gambirasio and C. Gervasoni, “Enterococcus gallinarum Endocarditis in a dIabetic Patient,” Diabetes Research and Clinical Practice, Vol. 81, No. 1, 2008, pp. e18-20.
[7] C. Spies, J. R. Madison and I. J. Schatz “Infective Endocarditis in Patients with End-Stage Renal Disease: Clinical Presentation and Outcome,” Archives of Internal Medicine, Vol. 164, No. 1, 2004, pp. 71-75.
[8] J. R. McDonald “Acute Infective Endocarditis,” Infectious Diseases Clinical of North American, Vol. 23, No. 3, 2009, pp. 643-664.
[9] H. R. Vikram, J. Buenconsejo, R. Hasbun and V. J. Quagliarello “Impact of Valve Surgery on 6-Month Mortality in Adults with Complicated, Left-Sided Native Valve Endocarditis” JAMA, Vol. 290, No. 24, 2003, pp. 3207-3214.
[10] D. J. Sexton and D. Spelman “Current Best Practices and Guidelines: Assessment and Management of Complications in Infective Endocarditis,” Cardiology Clinics, Vol. 21, No. 2, 2003, pp. 273-282.
[11] S. H. Choi, S. O. Lee, T. H. Kim, J. W. Chung, E. J. Choo, Y. G. Kwak, M. N. Kim, Y. S. Kim, J. H. Woo, J. Ryu and N. J. Kim “Clinical Features and Outcomes of Bacteremia Caused by Enterococcus casseliflavus and Enterococcus gallinarum: Analysis of 56 Cases,” Clinical Infectious Diseases, Vol. 38, No. 1, 2004, pp. 53-61.
[12] H. Koganemaru and S. Hitomi “Bacteremia Caused by VanC-Type Enterococci in a University Hospital in Japan: A 6-Year Survey,” Journal of Infection and Chemotherapy, Vol. 14, No. 6, 2008, pp. 413-417.

Copyright © 2023 by authors and Scientific Research Publishing Inc.

Creative Commons License

This work and the related PDF file are licensed under a Creative Commons Attribution 4.0 International License.