Enterococcus thailandicus as an uncommon pathogen in severe lower extremity trauma: a case report

Enterococcus thailandicus is a recently described enterococcal species with uncertain clinical significance. While Enterococcus faecium and Enterococcus faecalis are well recognized as nosocomial pathogens, clinical reports of E. thailandicus remain exceedingly rare. We report the case of a 46-year-old Thai male construction worker in Taiwan who sustained a severe forklift-related lower extremity injury in January 2025, including extensive degloving, tibialis anterior tendon rupture, and fibula fracture. Despite multiple surgical debridements and soft tissue reconstruction, he developed septic shock three days after admission. Tissue cultures from repeated debridements consistently yielded E. thailandicus. Antimicrobial susceptibility testing revealed susceptibility to penicillin, vancomycin, tigecycline, and levofloxacin. The patient ultimately underwent eight debridements followed by definitive soft tissue reconstruction with latissimus dorsi free flap and skin grafting. He recovered and was discharged 54 days after the initial trauma. This case highlights the possible clinical relevance of E. thailandicus in severe polymicrobial traumatic wound infections. Further studies are needed to clarify its virulence traits and antimicrobial resistance profile.