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Enterococcal infections in surgical patients: the mystery continues
1Department of Surgery, Tulane University School of Medicine, New Orleans, Louisiana 70112.
Abstract:
The frequency of isolation of enterococci from surgical patients has increased significantly during the past decade, although the role of these organisms as pathogens in mixed infections remains a mystery. Bacteremia and other infections in which enterococci are the only pathogens frequently result in high morbidity and mortality among patients unless specific antimicrobial therapy is initiated promptly. Debate continues concerning the necessity for treatment with such agents when this organism is isolated as a component of a polymicrobial infecting flora. Our recent data indicate that enterococci are rarely isolated in postoperative infections after penetrating abdominal trauma if no gastrointestinal perforation has occurred. However, they were found in 56% of postoperative infections of patients with gastrointestinal perforation. In contrast, enterococci were isolated in only 9% of cultures of specimens from patients with secondary suppurative peritonitis. The occurrence of superinfection after therapy with a cephalosporin appears to be an important factor in this finding. Future studies are necessary to evaluate the efficacy of antibiotic treatment of enterococcal infections and to assess the need for prophylaxis against enterococci.
Insights
Enterococci are increasingly found in surgical patients. While they cause severe infections alone, their role in mixed infections, especially after gastrointestinal perforation, requires further investigation.
Area of Science:
- Infectious Diseases
- Surgical Infections
- Microbiology
Background:
- Enterococci isolation in surgical patients has risen significantly over the last decade.
- The pathogenic role of enterococci in polymicrobial infections remains unclear.
- Prompt antimicrobial therapy is crucial for severe enterococcal infections (bacteremia) to reduce morbidity and mortality.
Purpose of the Study:
- To investigate the incidence and significance of enterococci in postoperative infections.
- To determine the association between gastrointestinal perforation and enterococcal isolation.
- To explore the impact of cephalosporin therapy on enterococcal superinfections.
Main Methods:
- Retrospective analysis of postoperative infection data.
- Comparison of enterococcal isolation rates in different surgical scenarios (e.g., trauma, perforation, peritonitis).
- Evaluation of factors influencing enterococcal presence in infections.
Main Results:
- Enterococci were rarely found in postoperative infections without gastrointestinal perforation.
- Enterococci were isolated in 56% of postoperative infections with gastrointestinal perforation.
- Enterococci were found in only 9% of secondary suppurative peritonitis cases, potentially linked to cephalosporin superinfection.
Conclusions:
- Enterococci are significant pathogens in postoperative infections, particularly those involving gastrointestinal perforation.
- The role of enterococci in polymicrobial infections warrants further study.
- Future research should focus on optimal antibiotic strategies and prophylaxis for enterococcal infections.