Vancomycin resistant Enterococcus faecium (VRE) vertebral osteomyelitis after uneventful spinal surgery: A case report and literature review

Abstract

Objective Case report and literature review. Background Enterococcus faecium is an emerging pathogen responsible for post procedural infections in patients who have undergone spinal decompression surgery. In this case report, the authors discuss and review recent literature on approaches to post-operative spinal infection. Case report We herein report the case of a 55-year-old HIV-negative Caucasian Italian woman who showed vertebral osteomyelitis with abscesses around the interbody cage caused by an Enterococcus faecium vancomycin resistant gen-Van A, following a Transforaminal Lumbar Interbody Fusion (TLIF). The same strain was detected in disc biopsy, urine culture and rectal swab. After the implant (screws, bars and cage) was removed and a suitable medical therapy administered, the infection resolved completely. The strain was identified and its susceptibility profile was characterized; biofilm-associated genes and biofilm-induced antimicrobial resistance is highlighted. Conclusions In any case, the management of infections complicating spinal surgery is controversial, and various mono or combined surgical and/or anti-infective timing approaches to remove infected implants have been proposed. The authors suggest a multidisciplinary approach taking into account virulence, microbiological features of causative pathogens and patient's risk factors. More efforts should be directed towards the early identification of pathogens in surgical specimens.