Background:

Vancomycin-resistant Enterococcus faecalis is a rare cause of community acquired infections.

Objective:

We present a case of urinary tract infection caused by vancomycin-resistant Enterococcus faecalis.

Patient and methods:

The patient was a 62-year-old woman hysterectomised 15 years ago. She reported four surgical interventions due to a cystocele. The last operation took place 11 years ago and she reported no further admittances at any hospital. In the last years the patient also suffered from repeated urinary tract infections. In the present episode she consulted because of typical UTI symptoms (dysuria, bladder tenesmus) and a urine sample was collected. After 24 h of incubation, a Gram positive coccus was isolated (more than 100 000 ufc/mL). The identification and susceptibility were preliminarily achieved by a commercially available method following manufacturer's recommendations (MicroScan, DADE). Identification was confirmed by API rapid strep system (BioMerieux). To discard Enterococcus species intrinsically resistant to vancomycin the absence of motility was observed with direct microscopic detection and the absence of pigmentation was determined by culture on TSA agar. Susceptibility to vancomycin, teicoplanin and ampicillin were assessed by disk diffusion, E-test and broth mcrodilution.

Results:

The isolated microorganism was identified as Enterococcus faecalis and showed high MICs to vancomycin (>128 mg/L by broth microdilution and 6 mm by disk diffusion) and teicoplanin (8 mg/L by broth microdilution and 10 mm by disk diffusion) but was susceptible to ampicillin (0.5 mg/L by broth microdilution).

Discussion:

The transmission ways of vancomycin resistant enterococci in the community and its clinical implications remain uncertain. In USA there is little evidence that VRE transmission may occur in the community. The opposite is true in Europe where these microorganisms have been isolated from different animal sources and healthy individuals. In our country, some studies have demonstrated the presence of VRE in animals and food.

Conclusion:

The identification of a VRE strain as the cause of a community-acquired urinary tract infection is an unusual finding and it may lay to important epidemiological implications.