# Surgical Treatment for Bacteremia due to Translocation of Enterococcus gallinarum: A Case Report

## TL;DR

A patient with antibiotic-resistant bacteremia caused by Enterococcus gallinarum was successfully treated with surgery and targeted decontamination.

## Contribution

This case report highlights surgical intervention as an effective treatment for refractory bacteremia due to E. gallinarum translocation.

## Key findings

- Surgical resection of the affected colon resolved sepsis caused by Enterococcus gallinarum translocation.
- Selective digestive decontamination via a mucous fistula aided recovery after surgery.
- No recurrence of bacteremia occurred after stoma closure six months later.

## Abstract

Bacterial translocation (BT) followed by bacteremia is usually managed with antibiotics, but some cases remain refractory. Herein, we report an immunocompromised patient with bacteremia due to the translocation of Enterococcus gallinarum, a rare pathogen among enterococcal infections, who was successfully treated with surgical intervention.

A 69-year-old woman with prior low anterior resection for rectal cancer developed adhesive intestinal obstruction during steroid treatment for suspected pyoderma gangrenosum. She progressed to septic shock despite antibiotics. CT revealed an edematous, thickened colon, suggesting ischemia or necrotizing colitis. An urgent laparotomy revealed no necrosis. The markedly edematous right colon was resected, with the creation of an ileostomy and a mucous fistula. Blood and colonic wall cultures both yielded Enterococcus gallinarum, confirming BT sepsis. Intravenous levofloxacin and selective digestive decontamination from the mucous fistula achieved recovery. Stoma closure was performed 6 months later without recurrence of bacteremia.

Intestinal resection serving as the portal of entry for BT should be considered in patients unresponsive to conservative management.