Recurrent bacteremic peritonitis caused by Enterococcus cecorum in a patient with liver cirrhosis

Enterococcus cecorum (formerly Streptococcus cecorum), originally isolated from poultry intestines, has rarely been encountered in human diseases. A 6 0-year-old man with liver cirrhosis and hepatocellular carcinoma developed peritonitis on the seventh day of his hospitalization. Cultures of one bloo d sample and one ascites fluid sample obtained on that day both grew E. cec orum. The patient received intravenous cefoxitin therapy and initially resp onded well. Unfortunately, another episode of peritonitis associated with s eptic shock developed 24 days after the start of treatment, and culture of one blood specimen yielded the same organism. The isolates were identified by the conventional biochemical tests, the API Rapid ID 32 Strep system, an d the API ZYM system (both systems from bioMerieux, Marcy L'Etoile, France) and were further confirmed by cellular fatty acid chromatography and 16S r RNA gene partial sequencing. The identical biotype, antibiotype, and random amplified polymorphic DNA pattern of the three isolates documented the lon g-term persistence of this organism in the patient. To the best of our know ledge, this is the first clinical description of recurrent bacteremic perit onitis caused by E. cecorum.