title: Are enterococci playing a role in postoperative peritonitis in critically ill patients?
abstract: This prospective non-interventional study is aimed at evaluating the role of enterococci in the postoperative course of postoperative peritonitis (POP) and the predictive factors for isolating Enterococcus spp. All adult patients, hospitalized in intensive care, who had POP between September 2006 and February 2010 were analysed. The patients' baseline clinical characteristics and microbiological and surgical characteristics of the first episode of POP were recorded. The rates of surgical and non-surgical complications and mortality were studied. A total of 139 patients were analysed and Enterococcus spp. were recovered in 61 patients (43%). The presence of enterococci was associated with significantly more intra-abdominal abscesses (26% vs 12%, p=0.025), but did not affect the rate of reoperation or mortality. Antibiotic use before reoperation was the only independent predictive factor for isolating enterococci (OR=2.19, CI95%: 1.02-4.70, p<0.043). Although mortality was not affected by the presence of Enterococcus spp., a higher rate of intra-abdominal abscess was found, suggesting that enterococci play a significant role in postoperative peritonitis, but the need to treat them remains to be determined. Previous antibiotic use before reoperation was a key factor in predicting the subsequent recovery of enterococci.
authors.affiliation: Service de Réanimation Chirurgicale, CHU Rennes, 35033, Rennes, France. philippe.seguin@chu-rennes.fr
authors.forename: P
authors.initials: P
authors.lastname: Seguin
authors.forename: C
authors.initials: C
authors.lastname: Brianchon
authors.forename: Y
authors.initials: Y
authors.lastname: Launey
authors.forename: B
authors.initials: B
authors.lastname: Laviolle
authors.forename: N
authors.initials: N
authors.lastname: Nesseler
authors.forename: P-Y
authors.initials: PY
authors.lastname: Donnio
authors.forename: Y
authors.initials: Y
authors.lastname: Malledant
mesh_terms: D018784:Abdominal Abscess / Q000453:epidemiology / Q000382:microbiology / Q000401:mortality; D000293:Adolescent; D000328:Adult; D000368:Aged; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D016638:Critical Illness; D004363:Drug Utilization / Q000706:statistics & numerical data; D016983:Enterococcus / Q000302:isolation & purification*; D005260:Female; D016908:Gram-Positive Bacterial Infections / Q000453:epidemiology* / Q000382:microbiology* / Q000401:mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D010538:Peritonitis / Q000453:epidemiology* / Q000382:microbiology* / Q000401:mortality; D011183:Postoperative Complications / Q000453:epidemiology* / Q000382:microbiology* / Q000401:mortality; D011446:Prospective Studies; D016019:Survival Analysis; D055815:Young Adult
chemical_list: D000900:Anti-Bacterial Agents
references.citation: Intensive Care Med. 2001 Nov;27(11):1685-8
references.pmid: 11810109
references.citation: Surg Infect (Larchmt). 2002 Fall;3(3):175-233
references.pmid: 12542923
references.citation: J Antimicrob Chemother. 2010 Feb;65(2):342-6
references.pmid: 20008043
references.citation: J Infect Dis. 1994 Apr;169(4):821-30
references.pmid: 8133097
references.citation: J Infect Dis. 1989 Jul;160(1):142-5
references.pmid: 2543707
references.citation: J Infect Dis. 1975 Sep;132(3):282-6
references.pmid: 1159331
references.citation: Infect Immun. 1976 Jan;13(1):22-6
references.pmid: 814099
references.citation: Ann Surg. 2003 Feb;237(2):235-45
references.pmid: 12560782
references.citation: Clin Infect Dis. 2001 Nov 1;33(9):1513-9
references.pmid: 11568851
references.citation: Br J Surg. 2002 Mar;89(3):361-7
references.pmid: 11872065
references.citation: Eur J Surg. 1999 Sep;165(9):875-84
references.pmid: 10533765
references.citation: Crit Care. 2009;13(3):R99
references.pmid: 19552799
references.citation: Ann Surg. 2000 Aug;232(2):254-62
references.pmid: 10903605
references.citation: Surgery. 1995 Oct;118(4):716-21; discussion 721-3
references.pmid: 7570327
references.citation: Crit Care. 2010;14(1):R20
references.pmid: 20156360
references.citation: J Clin Microbiol. 2010 Feb;48(2):456-9
references.pmid: 19940047
references.citation: Chest. 1992 Jun;101(6):1481-3
references.pmid: 1600757
references.citation: J Antimicrob Chemother. 2002 Oct;50(4):569-76
references.pmid: 12356803
references.citation: Antimicrob Agents Chemother. 2000 Aug;44(8):2028-33
references.pmid: 10898671
references.citation: Clin Infect Dis. 2010 Jan 15;50(2):133-64
references.pmid: 20034345
references.citation: Am J Respir Crit Care Med. 1994 Mar;149(3 Pt 1):818-24
references.pmid: 7509706
references.citation: Clin Microbiol Infect. 2006 Oct;12(10):980-5
references.pmid: 16961634