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The implications of enterococci for the intensive care unit Chatterjee I; Iredell JR; Woods M; Lipman JCrit Care Resusc 2007[Mar]; 9 (1): 69-75OBJECTIVE: To review the evidence of pathogenicity and virulence of Enterococcus spp. in the intensive care unit. DATA SOURCES: MEDLINE search for studies and articles on Enterococcus spp. RESULTS: Enterococcus spp. are normal commensal organisms in the alimentary tract and are traditionally considered to have relatively low virulence. However, they can cause a variety of life-threatening infections, especially in immunocompromised patients and nosocomial settings. The role of enterococci as primary pathogens in polymicrobial intra-abdominal infections remains controversial. There is enough evidence to suggest that complicated, community-acquired intra-abdominal infections involving mixed flora can be treated with surgery and non-enterococcal antibiotic cover. Recent studies have shown that enterococcal peritonitis is associated with increased mortality. CONCLUSIONS: Although the prevalence of enterococcal infections may be low in Australian ICUs, these infections are associated with a higher prevalence of treatment failure and mortality. We therefore suggest the use of enterococcal antibiotic coverage in: immunocompromised patients with a high risk of bacteraemia (eg, liver transplant patients); patients with peritonitis and valvular heart disease or prosthetic intravascular material; patients with severe sepsis of abdominal origin who have previously received broad spectrum antibiotics; and patients with persistent intra- abdominal collection without clinical improvement.|*Cross Infection/drug therapy/microbiology/prevention & control[MESH]|*Enterococcus/drug effects/isolation & purification[MESH]|*Gram-Positive Bacterial Infections/drug therapy/epidemiology[MESH]|*Intensive Care Units[MESH]|Aminoglycosides/pharmacology[MESH]|Anti-Bacterial Agents/pharmacology/therapeutic use[MESH]|Clindamycin/pharmacology[MESH]|Drug Resistance, Bacterial[MESH]|Humans[MESH]|Immunocompromised Host[MESH]|Infection Control[MESH]|Peritonitis/microbiology[MESH]|Risk Factors[MESH]|Vancomycin/pharmacology/therapeutic use[MESH]|beta-Lactams/pharmacology[MESH] |
