Acute Pyelonephritis with Enterococcus hirae and Literature Review

Ga Hee Lee; Hae Won Lee; Yoo Jin Lee; Bong Soo Park; Yang Wook Kim; Sihyung Park

doi:10.14777/uti.2017.12.01.49

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Lee, Lee, Lee, Park, Kim, and Park: Acute Pyelonephritis with Enterococcus hirae and Literature Review

Case Report

Urogenit Tract Infect 2017;12(1):49-53.

Published online: 19 April 2017

DOI: https://doi.org/10.14777/uti.2017.12.01.49

Acute Pyelonephritis with Enterococcus hirae and Literature Review

Ga Hee Lee, Hae Won Lee¹, Yoo Jin Lee¹, Bong Soo Park¹, Yang Wook Kim¹, Sihyung Park^1,

Department of Internal Medicine, Gimhae Jungang Hospital, Gimhae

¹Department of Internal Medicine, Inje University Haeundae Paik Hospital, Busan, Korea

Correspondence to: Sihyung Park http://orcid.org/0000-0002-6782-5299 Department of Internal Medicine, Inje University Haeundae Paik Hospital, 875 Haeun-daero, Haeundae-gu, Busan 48108, Korea Tel: +82-51-797-3324, Fax: +82-51-797-3282 E-mail: pakssyung@hanmail.net

Received 20 March 2017 Revised 10 April 2017 Accepted 10 April 2017

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

To control for acute infectious disease, identification of the causative agent and determining the antibiotic susceptibility of the pathogen are crucial. If a particular organism is rare and relevant etiological information is scarce, it becomes difficult to determine appropriate antibiotic and therapy duration. Enterococcus hirae is a pathogen that infects animals, but rarely causes human infections. We present two cases of E. hirae-related pyelonephritis with successful treatment. Herein, our experience is discussed with relevant literature review.

Keywords: Enterococcus, Pyelonephritis, Sepsis

REFERENCES

1.Canalejo E., Ballesteros R., Cabezudo J., Garcia-Arata MI., Moreno J. Bacteraemic spondylodiscitis caused by Enterococcus hirae. Eur J Clin Microbiol Infect Dis. 2008. 27:613–5.

2.Pai H. Treatment of community-acquired uncomplicated urinary tract infection. Korean J Med. 2011. 81:685–9.

3.McNamara EB., King EM., Smyth EG. A survey of antimicrobial susceptibility of clinical isolates of Enterococcus spp. from Irish hospitals. J Antimicrob Chemother. 1995. 35:185–9.

4.Kim KH., Yoon JH., Kim TH., Yoon HJ., Cheon JY., Jin SJ, et al. A case of acute pyelonephritis caused by enterococcus hirae in a patient with a horseshoe kidney. Korean J Med. 2014. 87:369–72.

5.Kim HI., Lim DS., Seo JY., Choi SH. A case of pyelonephritis accompanied by enterococcus hirae bacteremia. Infect Chemother. 2009. 41:359–61.

6.Moore DF., Zhowandai MH., Ferguson DM., McGee C., Mott JB., Stewart JC. Comparison of 16S rRNA sequencing with conventional and commercial phenotypic techniques for identification of enterococci from the marine environment. J Appl Microbiol. 2006. 100:1272–81.

7.Chan TS., Wu MS., Suk FM., Chen CN., Chen YF., Hou YH, et al. Enterococcus hirae-related acute pyelonephritis and cholangitis with bacteremia: an unusual infection in humans. Kaohsiung J Med Sci. 2012. 28:111–4.

8.Paosinho A., Azevedo T., Alves JV., Costa IA., Carvalho G., Peres SR, et al. Acute pyelonephritis with bacteremia caused by enterococcus hirae: a rare infection in humans. Case Rep Infect Dis. 2016. 2016:4698462.

9.Brule N., Corvec S., Villers D., Guitton C., Bretonniere C. Life-threatening bacteremia and pyonephrosis caused by Enterococcus hirae. Med Mal Infect. 2013. 43:401–2.

10.Park J., Uh Y., Jang IH., Yoon KJ., Kim SJ. A case of enterococcus hirae septicemia in a patient with acute pyelonephritis. Korean J Clin Pathol. 2000. 20:501–3.

Fig. 1.

Computed tomography scans of the first patient. (A) Contrast-enhanced phase; prominent wall thickening and enhancement in both ureters (line arrows). (B) Delayed phase; multifocal wedge shaped poor enhancing lesion in the left kidney (dotted line arrow).

Fig. 2.

Antibiogram of the first patient. Left column for blood culture result and right column for urine culture result.

Fig. 3.

Computed tomography scans of the second patient. (A) Contrast-enhanced (B) delayed phase show diffuse left renal swelling and left perinephric fat infiltration. Diffuse wall thickening of the left ureter (line arrow). Simple renal cyst (dotted line arrow).

Fig. 4.

Antibiogram of the second patient. Urine culture.

Table 1.

Reported cases of human infections (acute pyelonephritis) due to Enterococcus hirae

Origin	Reference	Year	Sex/age (y)	Morbidity	Culture	Treatment	Day
Domestic	Park et al. [10]	2000	F/21	Birth control pill	B	FLO+ISP→AMP+ISP	10
	Kim et al. [5]	2009	F/57	Rheumatoid arthritis	B, U	CIP→ CRO+AG→AM-SB	14
	Kim et al. [4]	2014	M/84	Horseshoe kidney	U	CIP→AM-SB	14
Overseas	Chan et al. [7]	2012	F/62	Constipation	U	CFZ+Gent→AMP→Amox	12
	Paosinho et al. [8]^a)	2016	F/78	Afib, CKD	U	AM-CL→PIP-TZ	14
	Brule et al. [9]^b)	2013	M/44	ALD, DCMP	B, U	CRO+Metro+AMK→Amox	x 25

F: female, B: blood, FLO: flomoxef sodium, ISP: isepamicin, AMP: ampicillin, U: urine, CIP: ciprofloxacin, CRO: ceftriaxone, AG: aminoglycoside, AM-SB: ampicillin-sulbactam, M: male, CFZ: cefazolin, Gent: gentamicin, Amox: amoxicillin, Afib: atrial fibrillation, CKD: chronic kidney disease, AM-CL: amoxicillin-clavulanic acid, PIP-TZ: piperacillin-tazobactam, ALD: alcoholic liver disease, DCMP: dilated cardiomyopathy, Metro: metronidazole, AMK: amikacin.

^a) Co-infection with Escherichia coli,

^b) pyonephrosis.

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