Tariq Butt, Rifat Nadeem Ahmad, Muhammad Usman, Raja Kamran Afzal, Umar Khurshid.
Emergence of Vancomycin-resistant Enterococcus faecium in northern Pakistan.
Pak Armed Forces Med J Jan ;54(2):275-6.

A 31 years old mad, who had undergone renal transplant 1 year back, presented with chronic graft rejection. His renal function deteriorated progressively and he had to undergo hemodialysis thrice weekly. He was administered iv vancomycin 1gm infusion before each dialysis as prophylaxis against methicillin-resistant staphylococcus aureus (MRSA). Patients had repeated episodes of fever and urinary tract infections. E. Coli was isolated from his urine for which he received iv meropenem and MRSA was isolated from his blood and throat. The MRSA islates were susceptible to vancomycin and teicoplanin. Later on, he also developed inection at the site of AV fistula on his left forearm. Blood and pus specimens were sent and Enterococcus Faecium was isolated. Patient expired before the culture report could be finalized. Isolate was identified and found resistant to all drugs (including vancomycin, teicoplanin) except fusidic acid and co-trimoxazole.

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