The following is a summary of “Vancomycin-resistant Enterococcus (VRE) Pneumonia in a Patient With Advanced Chronic Obstructive Pulmonary Disease (COPD),” published in the October 2024 issue of Pulmonology by Nedunchezhian et al.

Vancomycin-resistant Enterococcus (VRE) is a common cause of hospital-acquired infections in the abdomen, genitourinary tract, and bloodstream.

Researchers conducted a retrospective study examining VRE pneumonia in a patient with a history of advanced chronic obstructive pulmonary disease (COPD) and gastrointestinal pathology predisposing to aspiration.

The case involves a 75-year-old woman with advanced COPD/emphysema (on 4-6 L home oxygen), chronic hypoxemic respiratory failure, multiple sclerosis in remission, and a history of gastrointestinal AVMs. She was initially presented with anemia and dyspnea and was treated for bleeding AVMs with argon plasma coagulation, complicated by lidocaine aspiration leading to aspiration pneumonitis. She recovered with conservative management and no antibiotics.

Additionally, 6 weeks later, she returned with worsening dyspnea and a productive cough. Imaging showed left-sided airspace opacities. She was treated initially for pneumonia with broad antibiotics, and her tests for common infections were negative. Bronchoscopy ruled out abscess, infection, and malignancy, but sputum culture later grew vancomycin-resistant *Enterococcus faecium*. She improved after a seven-day course of oral Linezolid.

In discussion, nosocomial enterococcal infections were rising, but VRE pneumonia remained rare and challenging to diagnose, with high mortality. Reported cases often involve elderly patients with immunosuppression, malignancies, or COPD. The patient had risk factors like previous hospitalization for argon photocoagulation (bleeding AVMs), aspiration, chronic proton pump inhibitor use, and advanced COPD but was not on mechanical ventilation, a standard risk in prior cases. Despite improving leukocytosis, pneumonia persisted. After bronchoalveolar lavage (BAL) was inconclusive, VRE was isolated from sputum, and the patient improved with targeted treatment. Rising multi-drug resistance makes VRE a consideration in unresponsive pneumonia, particularly with aspiration and lung disease.

They concluded that VRE pneumonia was rare, and structural lung disease might hinder infection resolution.

Source: journal.chestnet.org/article/S0012-3692(24)01517-4/fulltext