Six Cases of Severe Acute Pancreatitis Complicated With Vancomycin-Resistant Enterococcus Enteritis
Six Cases of Severe Acute Pancreatitis Complicated With Vancomycin-Resistant Enterococcus Enteritis
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DOI：
10.1097/shk.0000000000000237
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发表时间：
2014-11
期刊：
影响因子：
3.1
通讯作者：
Yun Zhang;Shunliang Gao;Shao-yang Zhang;Zhong-yan Liang;Wen-qiao Yu;T. Liang
中科院分区：
文献类型：
--
作者：
Yun Zhang;Shunliang Gao;Shao-yang Zhang;Zhong-yan Liang;Wen-qiao Yu;T. Liang
ABSTRACT Objective: The objective of this study was to explore the clinical manifestations and possible mechanisms of vancomycin-resistant enterococcus (VRE)–induced severe enteritis and extraenteric disseminations. Methods: In six patients with severe acute pancreatitis (SAP) complicated with acute infectious diarrhea, VRE was confirmed by bacterial genotyping, minimum inhibitory concentration testing, and empiric linezolid treatment. Samples collected from stools and peripancreatic effusions were used to compare the genotypes of VRE by pulsed-field gel electrophoresis and multilocus sequence typing and to validate the suspected extraenteric disseminations caused by VRE. To further elucidate the mechanisms of VRE-inflicted enteric mucosal injury, in vitro infection of human intestinal Caco-2 cell line with VRE was performed followed by inflammatory cytokine assays and morphological characterization by electron microscopy. Results: All six VRE strains isolated from stool samples caused severe enteritis in SAP patients. The same strains further inflicted significant damage and induced inflammatory reactions in Caco-2 cells. Homologous assays demonstrated high homology between samples from stool and peripancreatic effusions in two patients, indicating the occurrence of extraenteric disseminations. Conclusions: Alterations in drug resistance and virulence of enterococci, part of the symbiotic bacteria, during the course of SAP may cause inflammatory injuries to enteric epithelium, resulting in enteritis and extraenteric disseminations.
