Figure 4
Serial quantitative culture of gastrointestinal carriage of vancomycin-resistant Enterococcus faecium and concomitant use of antimicrobial agents in case 4. Note. Intravenous ampicillin 2 gm iv q8h, and gentamicin 40 mg iv q8h were given from the referral hospital for treatment of infective endocarditis due to viridans streptococci. Antibiotic was changed to benzyl penicillin 3 MU iv q4h on day 7 upon clinical consultation to microbiologist, and stopped on day 17 of hospitalization after completion of treatment. Meropenem 500 mg iv q12h and one dose of daptomycin 350 mg iv was given on day 25 for systemic sepsis complicating mesenteric ischemia and bowel gangrene. Patient succumbed on day 26 of hospitalization despite maximal supportive therapy. The dotted horizontal line denoted the detection limit of VRE in fecal samples by broth enrichment ~ 200 cfu/g (2.3 log10 cfu/g).