The implications of enterococci for the intensive care unit.
OBJECTIVE
To review the evidence of pathogenicity and virulence of Enterococcus spp. in the intensive care unit.


METHODS
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.
Chatterjee
Indranil
I
Department of Intensive Care Medicine, Royal Brisbane and Women's Hospital, Brisbane, QLD, Australia. ic94@rediffmail.com
Iredell
Jonathan R
JR
Woods
Marion
M
Lipman
Jeffrey
J
D000617:Aminoglycosides / Q000494:pharmacology; D000900:Anti-Bacterial Agents / Q000494:pharmacology / Q000627:therapeutic use; D002981:Clindamycin / Q000494:pharmacology; D003428:Cross Infection / Q000188:drug therapy / Q000382:microbiology / Q000517:prevention & control; D024881:Drug Resistance, Bacterial; D016983:Enterococcus / Q000187:drug effects / Q000302:isolation & purification; D016908:Gram-Positive Bacterial Infections / Q000188:drug therapy / Q000453:epidemiology; D006801:Humans; D016867:Immunocompromised Host; D017053:Infection Control; D007362:Intensive Care Units; D010538:Peritonitis / Q000382:microbiology; D012307:Risk Factors; D014640:Vancomycin / Q000494:pharmacology / Q000627:therapeutic use; D047090:beta-Lactams / Q000494:pharmacology
D000617:Aminoglycosides; D000900:Anti-Bacterial Agents; D047090:beta-Lactams; D002981:Clindamycin; D014640:Vancomycin