Enterococcus hirae Bacteremia in an Infant: Case Report and Review of the Literature

Abstract

Enterococcus hirae is a gram-positive coccus that is rarely implicated in human disease and has not been reported in pediatric patients. We report a case of catheter-associated bloodstream infection and prolonged bacteremia in a 7-month-old infant dependent on total parenteral nutrition. The species was identified by the VITEK2 system and confirmed by matrix-assisted laser desorption/ionization time-of-flight (MALDI-TOF) mass spectrometry. The organisms was susceptible to ampicillin, vancomycin, and high-level gentamicin. The patient was treated with vancomycin and gentamicin with adjunctive vancomycin lock therapy but had persistent bacteremia. Therapy was changed to dual β-lactam therapy of ampicillin and ceftriaxone with synergistic gentamicin, which led to clearance of the enterococcal bacteremia. E hirae is an unusual species that may be difficult for the microbiology laboratory to identify. This is the first pediatric case and the second case of invasive E hirae in the United States.

Enterococcus hirae bacteremia associated with acute pyelonephritis in a patient with alcoholic cirrhosis: a case report and literature review

“…Only 31 human cases of E. hirae have been reported (Table 2). Of these, urinary tract infections [3-5, 12, 14, 18], biliary tract infections [5,12], and infective endocarditis [6][7][8][9][10][11] accounted for the majority of cases, with catheter-related bloodstream infections [12,19], peritonitis [20,21], splenic abscess [22], and pneumonia [17] also being reported. Patients were predominantly male (n = 20, 64.5%), similar to predominance in infections caused by other Enterococcus spp.…”

Genomic Characterization of Enterococcus hirae From Beef Cattle Feedlots and Associated Environmental Continuum

“…There are over 50 species of enterococci with E. faecalis and E. faecium most frequently linked to human infections. Occasionally, other species including E. hirae, E. avium, E. durans, E. gallinarum, E. casseliflavus, and E. raffinosus may also be associated with infections in people ( Brayer et al, 2019 ; Pinkes et al, 2019 ; Winther et al, 2020 ). Due to their widespread occurrence and persistence in the environment, enterococci are considered indicators of fecal contamination ( Byappanahalli and Fujioka, 2004 ; Yan et al, 2011 ) and also serve as key indicator bacteria for AMR surveillance systems in humans and animals ( Harwood et al, 2000 ; Layton et al, 2010 ).…”