Are there patients with peritonitis who require empiric therapy for enterococcus?

Area of Science:

• Infectious Diseases
• Microbiology
• Surgical Infections

Background:

• Enterococci are an emerging cause of nosocomial infections, with established roles in bacteremia and super-infections.
• The role of enterococci as primary pathogens in polymicrobial intra-abdominal infections (IAIs) is debated.
• Some evidence suggests enterococci increase post-operative complications, while others show successful treatment without enterococcal coverage.

Purpose of the Study:

• To evaluate the necessity of including antibiotic coverage against enterococci in the empirical treatment of peritonitis in specific high-risk patient groups.
• To review the literature regarding the management of IAIs involving enterococci.

Main Methods:

• Extensive literature review on enterococcal IAIs and treatment strategies.
• Analysis of evidence for empirical enterococcal coverage in peritonitis.

Main Results:

• Evidence supports empirical enterococcal coverage for specific high-risk IAIs.
• High-risk groups include immunocompromised patients with nosocomial peritonitis, patients with severe sepsis previously treated with broad-spectrum antibiotics, and those with valvular heart disease or prosthetic intravascular material.

Conclusions:

• Empirical antibiotic therapy including enterococcal coverage should be considered for specific high-risk patient populations with IAIs.
• The optimal therapeutic regimen for these patients requires further determination.
• Enterococcal coverage is a key consideration in managing complex intra-abdominal infections.