title: Six cases of severe acute pancreatitis complicated with vancomycin-resistant enterococcus enteritis.
abstract: OBJECTIVE
  The objective of this study was to explore the clinical manifestations and possible mechanisms of vancomycin-resistant enterococcus (VRE)-induced severe enteritis and extraenteric disseminations.
  
  
  METHODS
  In six patients with severe acute pancreatitis (SAP) complicated with acute infectious diarrhea, VRE was confirmed by bacterial genotyping, minimum inhibitory concentration testing, and empiric linezolid treatment. Samples collected from stools and peripancreatic effusions were used to compare the genotypes of VRE by pulsed-field gel electrophoresis and multilocus sequence typing and to validate the suspected extraenteric disseminations caused by VRE. To further elucidate the mechanisms of VRE-inflicted enteric mucosal injury, in vitro infection of human intestinal Caco-2 cell line with VRE was performed followed by inflammatory cytokine assays and morphological characterization by electron microscopy.
  
  
  RESULTS
  All six VRE strains isolated from stool samples caused severe enteritis in SAP patients. The same strains further inflicted significant damage and induced inflammatory reactions in Caco-2 cells. Homologous assays demonstrated high homology between samples from stool and peripancreatic effusions in two patients, indicating the occurrence of extraenteric disseminations.
  
  
  CONCLUSIONS
  Alterations in drug resistance and virulence of enterococci, part of the symbiotic bacteria, during the course of SAP may cause inflammatory injuries to enteric epithelium, resulting in enteritis and extraenteric disseminations.
authors.affiliation: *The Department of Hepatobiliary and Pancreatic Surgery, the Second Affiliated Hospital, Zhejiang University School of Medicine; †The Women's Hospital Affiliated to Zhejiang University School of Medicine; and ‡The Department of Intensive Care Unit, Sir Run Run Shaw Hospital Affiliated to Zhejiang University School of Medicine, Hangzhou, Zhejiang, China.
authors.forename: Yun
authors.initials: Y
authors.lastname: Zhang
authors.forename: Shun-Liang
authors.initials: SL
authors.lastname: Gao
authors.forename: Shao-Yang
authors.initials: SY
authors.lastname: Zhang
authors.forename: Zhong-Yan
authors.initials: ZY
authors.lastname: Liang
authors.forename: Wen-Qiao
authors.initials: WQ
authors.lastname: Yu
authors.forename: Ting-Bo
authors.initials: TB
authors.lastname: Liang
mesh_terms: D000208:Acute Disease; D000328:Adult; D000368:Aged; D018938:Caco-2 Cells; D016207:Cytokines / Q000378:metabolism; D003967:Diarrhea / Q000209:etiology; D004751:Enteritis / Q000150:complications* / Q000000981:diagnostic imaging / Q000382:microbiology; D005260:Female; D016908:Gram-Positive Bacterial Infections / Q000150:complications* / Q000000981:diagnostic imaging / Q000382:microbiology; D006801:Humans; D008297:Male; D008826:Microbial Sensitivity Tests / Q000379:methods; D008875:Middle Aged; D009894:Opportunistic Infections / Q000150:complications* / Q000000981:diagnostic imaging / Q000382:microbiology; D010195:Pancreatitis / Q000150:complications* / Q000000981:diagnostic imaging; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed; D065507:Vancomycin-Resistant Enterococci / Q000472:pathogenicity*; D014774:Virulence
chemical_list: D016207:Cytokines