I've recently seen an adult patient with fimosis and a Vancomycin-resistant Enterococcus faecalis isolated from his urthera. There were no local signs of inflammation or infection and the antibiogram showed sensitivity only to Tigecylcine and Linezolid. This was no mistake; a repeat culture from a urethral swab grew the same organism with the same antibiogram. The patient suffers from non-Hodgkin's lymphoma and is sheduled for an autologous stem cell transplant in March. His oncologist said that he needs to be "infection-free" at that time. So the patient wants to be treated for this newly-identified "infection".
I refused to do so because I see no active sign of infection and I suspect this is simply a colonzation from his colon. But is it warranted/possible to eradicate colonization with VRE (with Linezolid for instance) given the particular circumstances of this case?
I'm not an oncologist, so I don't want to give a recommendation in favor for or against decolonization. From a clinical microbiologist view I would say, it doesnt make sense to treat a "diagnostic microbiology report". Saying this means, we may detect facultative pathogenic bacteria at a given location (with or without resistance markers) but the decision for treatment needs the clinical context (as you say). If there is no sign of inflammation or 'disease', it might indeed be colonization and not infection. Colonization might be an issue from a hygienic perspective and it might become an issue under immuno-suppression. For that, it is important to know that the patient is colonized with VRE and to closely monitor the patient for signs of infection.
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