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Colonization and infection with Enterococcus faecalis in intensive care units: the role of antimicrobial agents
M J Bonten1, C A Gaillard, F H van Tiel
1Department of Internal Medicine, University of Hospital Maastricht, The Netherlands.
Abstract:
We studied the influences of antimicrobial agents on the colonization of the respiratory tract and infection with Enterococcus faecalis in intensive care unit (ICU) patients receiving mechanical respiration for at least 3 days. In a matched-cohort analysis, patients receiving topical antimicrobial prophylaxis (TAP) of the oropharynx and stomach with antimicrobial agents not treating E. faecalis were compared with patients not receiving TAP. Patients were matched with controls on the basis of their duration in the ICU, their use of systemic antibiotics treating and not treating E. faecalis, the administration of TAP, their APACHE II score, and surgical procedures they had undergone. In all, 276 patients were analyzed. The colonization of the oropharynx and/or trachea by E. faecalis at admission was demonstrated for 43 patients (16%). Twenty patients (9%) acquired tracheal colonization and 91 patients (40%) acquired oropharyngeal colonization with E. faecalis. In the matched-cohort analysis, 43 patients receiving TAP were matched in two controls each. TAP patients more frequently acquired tracheal colonization (15 of 43 versus 2 of 86 patients, P < 0.00001) and infections with E. faecalis (6 of 43 versus 1 of 86 patients, P < 0.01). The use of topical antibiotics and treating E. faecalis increased the risk for colonization and infection with E. faecalis.
Insights
Topical antimicrobial prophylaxis (TAP) in intensive care unit (ICU) patients receiving mechanical ventilation increased Enterococcus faecalis colonization and infection risks. This highlights potential dangers of non-targeted antimicrobial use in critical care settings.
Area of Science:
- Critical Care Medicine
- Infectious Diseases
- Microbiology
Background:
- Enterococcus faecalis is a significant pathogen in intensive care units (ICUs).
- Mechanical ventilation prolongs ICU stays and increases infection risks.
- The impact of topical antimicrobial prophylaxis (TAP) on E. faecalis colonization and infection in ventilated patients is not well understood.
Purpose of the Study:
- To investigate the influence of TAP on respiratory tract colonization and infection with Enterococcus faecalis in ICU patients on mechanical ventilation.
- To compare outcomes between patients receiving TAP and those not receiving TAP.
Main Methods:
- Matched-cohort analysis of 276 ICU patients receiving mechanical ventilation for at least 3 days.
- Patients receiving TAP (oropharynx and stomach) with agents not targeting E. faecalis were compared to controls not receiving TAP.
- Matching criteria included ICU duration, systemic antibiotic use, TAP administration, APACHE II score, and surgical procedures.
Main Results:
- At admission, 16% of patients had E. faecalis colonization.
- 40% acquired oropharyngeal and 9% acquired tracheal colonization during ICU stay.
- Patients receiving TAP showed significantly higher rates of tracheal colonization (15/43 vs. 2/86, P < 0.00001) and E. faecalis infection (6/43 vs. 1/86, P < 0.01).
Conclusions:
- The use of TAP, particularly with agents not targeting E. faecalis, is associated with an increased risk of E. faecalis colonization and infection in mechanically ventilated ICU patients.
- These findings suggest that non-targeted topical antimicrobial use may disrupt the normal flora, promoting pathogen overgrowth.
- Careful consideration of antimicrobial selection and administration strategies is warranted in critical care settings to mitigate risks associated with E. faecalis.