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January 1985, Vol 120, No. 1 >
ARTICLE | January 1985

Enterococcal Bacteremia in Surgical Patients FREE

David T. Barrall, MD; Pardon R. Kenney, MD; Gus J. Slotman, MD; Kenneth W. Burchard, MD
[+] Author Affiliations

Accepted for publication Sept 12, 1984.

Read before the Fourth Annual Meeting of the Surgical Infection Society, Montreal, April 30, 1984.

Reprint requests to Rhode Island Hospital, 593 Eddy St, Providence, RI 02903 (Dr Burchard).


Arch Surg. 1985;120(1):57-63. doi:10.1001/archsurg.1985.01390250049008
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• In 73 surgical patients enterococcal bacteremia was preceded by antibiotic administration (n = 58), central venous catheters (n = 52), other-organism bacteremia (n = 44), and gastrointestinal tract operations (n = 41). Surgical wounds and urinary tract infections were the most frequent portal of entry. The overall mortality was 42%. The mortality risk was significantly greater in patients with preceding or concomitant gram-positive bacteremia and four or more days of cephalosporin administration prior to enterococcemia. In 21 patients who had been given cephalosporins and who had gram-positive bacteremia, specific antienterococcal therapy resulted in survival in five of nine patients, compared with three of 12 who survived without therapy. Enterococcal bacteremia in surgical patients follows antibiotic administration, central venous catheter use, other-organism bacteremia, and intra-abdominal operations. Preceding or concomitant gram-positive bacteremia defines a subgroup of patients with high mortality who seem to respond to antienterococcal therapy.

(Arch Surg 1985;120:57-63)

REFERENCES

1 +
Faro S, Pastorek JG II:  The enterococcus: Myth or reality in ob-gyn infections? Infect Surg 1983;;2:787-794.
2 +
Kaye D:  Enterococci: Biologic and epidemiologic characteristics and in vitro susceptibility . Arch Intern Med 1982;;142:2006-2009.
3 +
Rantz LA, Kirby WMM:  Enterococcic infections . Arch Intern Med 1943;;71:516-528.
4 +
Bayer AS, Seidel JS, Yoshikawa TT, et al:  Group D enterococcal meningitis . Arch Intern Med 1976;;136:883-886.
5 +
Shlaes DM, Levy J, Wolinsky E:  Enterococcal bacteremia without endocarditis . Arch Intern Med 1981;;141:578-581.
6 +
Garrison RN, Fry DE, Berberich S, et al:  Enterococcal bacteremia: Clinical implications and determinants of death . Arch Surg 1982;;196:43-47.
7 +
Dougherty SH, Flohr AB, Simmons RL:  Breakthrough enterococcal septicemia in surgical patients . Arch Surg 1983;;118:232-238.
8 +
Ing AFM, McLean PH, Meakins JL:  Multiple-organism bacteremia in the surgical intensive care unit: A sign of intraperitoneal sepsis . Surgery 1981;;90:779-786.
9 +
Whiteside M, Moore J, Ratzan K:  An investigation of enterococcal bacteremia . Am J Infect Control 1983;;11:125-129.
10 +
Kiani D, Quinn EL, Burch KH, et al:  The increasing importance of polymicrobial bacteremia . JAMA 1979;;242:1044-1047.
11 +
Siegel S: Nonparametric Statistics . New York, McGraw-Hill Book Co, 1956;, p 104.
12 +
Wilson GS, Miles A: Principles of Bacteriology, Virology, and Immunity , Baltimore, Williams & Wilkins Co, 1975;.
13 +
Yu VL:  Enterococcal superinfection and colonization after therapy with moxalactam, a new broad-spectrum antibiotic . Ann Intern Med 1981;; 94:784-785.
14 +
Burchard KW, Minor LB, Slotman GJ, et al:  Fungal sepsis in surgical patients . Arch Surg 1983;;118:217-221.
15 +
Burchard KW, Minor LB, Slotman GJ, et al:  Staphylococcus epidermidis sepsis in surgical patients . Arch Surg 1984;;119:96-100.
16 +
Onderdonk AB, Bartlett JG, Louis T, et al:  Microbial synergy in experimental intra-abdominal abscess . Infect Immunol 1976;;13:22-26.
17 +
Maki DG, Weise CE, Sarafin HW:  A semiquantitative culture method for identifying intravenous-catheter-related infection . N Engl J Med 1977;; 296:1305-1309.
18 +
Whiteside M, Moore J, Ratzan K:  An investigation of enterococcal bacteremia . Am J Infect Control 1983;;11:125-129.

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1 +
Faro S, Pastorek JG II:  The enterococcus: Myth or reality in ob-gyn infections? Infect Surg 1983;;2:787-794.
2 +
Kaye D:  Enterococci: Biologic and epidemiologic characteristics and in vitro susceptibility . Arch Intern Med 1982;;142:2006-2009.
3 +
Rantz LA, Kirby WMM:  Enterococcic infections . Arch Intern Med 1943;;71:516-528.
4 +
Bayer AS, Seidel JS, Yoshikawa TT, et al:  Group D enterococcal meningitis . Arch Intern Med 1976;;136:883-886.
5 +
Shlaes DM, Levy J, Wolinsky E:  Enterococcal bacteremia without endocarditis . Arch Intern Med 1981;;141:578-581.
6 +
Garrison RN, Fry DE, Berberich S, et al:  Enterococcal bacteremia: Clinical implications and determinants of death . Arch Surg 1982;;196:43-47.
7 +
Dougherty SH, Flohr AB, Simmons RL:  Breakthrough enterococcal septicemia in surgical patients . Arch Surg 1983;;118:232-238.
8 +
Ing AFM, McLean PH, Meakins JL:  Multiple-organism bacteremia in the surgical intensive care unit: A sign of intraperitoneal sepsis . Surgery 1981;;90:779-786.
9 +
Whiteside M, Moore J, Ratzan K:  An investigation of enterococcal bacteremia . Am J Infect Control 1983;;11:125-129.
10 +
Kiani D, Quinn EL, Burch KH, et al:  The increasing importance of polymicrobial bacteremia . JAMA 1979;;242:1044-1047.
11 +
Siegel S: Nonparametric Statistics . New York, McGraw-Hill Book Co, 1956;, p 104.
12 +
Wilson GS, Miles A: Principles of Bacteriology, Virology, and Immunity , Baltimore, Williams & Wilkins Co, 1975;.
13 +
Yu VL:  Enterococcal superinfection and colonization after therapy with moxalactam, a new broad-spectrum antibiotic . Ann Intern Med 1981;; 94:784-785.
14 +
Burchard KW, Minor LB, Slotman GJ, et al:  Fungal sepsis in surgical patients . Arch Surg 1983;;118:217-221.
15 +
Burchard KW, Minor LB, Slotman GJ, et al:  Staphylococcus epidermidis sepsis in surgical patients . Arch Surg 1984;;119:96-100.
16 +
Onderdonk AB, Bartlett JG, Louis T, et al:  Microbial synergy in experimental intra-abdominal abscess . Infect Immunol 1976;;13:22-26.
17 +
Maki DG, Weise CE, Sarafin HW:  A semiquantitative culture method for identifying intravenous-catheter-related infection . N Engl J Med 1977;; 296:1305-1309.
18 +
Whiteside M, Moore J, Ratzan K:  An investigation of enterococcal bacteremia . Am J Infect Control 1983;;11:125-129.

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