Does Isolation of Enterococcus Affect Outcomes in Intra-Abdominal Infections?

Area of Science:

• Infectious Diseases
• Clinical Microbiology
• Surgical Infections

Background:

• Enterococci are frequently isolated in intra-abdominal infections (IAIs) and are associated with adverse clinical outcomes.
• The clinical significance and optimal antimicrobial treatment strategy for IAIs involving Enterococcus remain debated.

Purpose of the Study:

• To determine if Enterococcus isolation in IAIs independently predicts adverse clinical outcomes.
• To evaluate if the presence of Enterococcus necessitates an altered antimicrobial treatment approach for IAIs.

Main Methods:

• Post hoc analysis of the Study to Optimize Peritoneal Infection Therapy (STOP-IT) trial database.
• Stratification of 518 patients into Enterococcus-positive (n=50) and Enterococcus-negative groups.
• Uni-variable and multi-variable analyses to assess Enterococcus as a predictor of a composite outcome (surgical site infection, recurrent IAI, or death).

Main Results:

• Enterococcus spp. were identified in 50 patients, with Enterococcus faecalis being predominant.
• No statistically significant differences were observed in baseline characteristics, infection origins, or antibiotic utilization between groups.
• Clinical outcomes, including surgical site infection, recurrent IAI, and death, were comparable between Enterococcus-positive and negative groups.
• Multi-variable analysis confirmed that Enterococcus isolation did not independently predict the composite outcome (OR 1.53, p=0.22).

Conclusions:

• Enterococcus is not a more common pathogen in health-care-associated IAIs.
• Isolation of Enterococcus in IAIs is not an independent risk factor for adverse composite outcomes.
• Current antimicrobial treatment strategies for IAIs do not require modification based solely on Enterococcus presence, though larger studies are needed.