title: [Enterococci and surgical site infections : Causal agent or harmless commensals?]
abstract: BACKGROUND
  The role of enterococci in the context of peritonitis and surgical site infections (SSI) has not yet been definitively clarified but enterococci are being detected more frequently. Numerous resistances reduce the available antibiotic options.
  
  
  OBJECTIVE
  This article gives an overview of the pathogenic importance of enterococci and of current recommendations for therapy and prophylaxis. On the basis of our own data we discuss the relevance of enterococci for SSI.
  
  
  METHODS
  All colorectal resections carried out between January 2008 and September 2016 were retrospectively documented. Revision surgery, SSI and intra-abdominally or subcutaneously detected pathogens were recorded.
  
  
  RESULTS
  A total of 2713 interventions were evaluated with 28.3% having primary peritonitis. In 587 patients (21.6%) SSI followed, and pathogen determination was possible in 431 cases (73.4%). Enterococci were frequently found in re-operations (58.4%) and SSI (46.1%), with E. faecalis and E. faecium in approximately equal proportions. If intra-abdominal enterococci were detectable in patients with primary peritonitis, it was more common to develop SSI and enterococci were more frequently detected subcutaneously. Enterococci in SSI were found to be significantly more frequent in left hemicolectomies as well as in pre-existing renal insufficiency.
  
  
  CONCLUSIONS
  It can be inferred that enterococci are not adequately covered by commonly used perioperative antibiotic therapy or preoperative prophylaxis, which increases the risk for SSI by enterococci. This could be favored by selection of these pathogens due to the use of antibiotics without enterococcal efficacy (e. g. cephalosporins). The consideration in the choice of perioperative antibiotic prophylaxis by the additional administration of ampicillin or vancomycin could be advantageous.
authors.affiliation: Klinik für Allgemein-, Viszeral- und Thoraxchirurgie, Marienhospital Stuttgart, Vinzenz von Paul Kliniken, Böheimstr. 39, 70199, Stuttgart, Deutschland. julius.pochhammer@vinzenz.de.
authors.forename: J
authors.initials: J
authors.lastname: Pochhammer
authors.affiliation: Institut für Hygiene und Umweltmedizin, Universitätsmedizin Greifswald, Greifswald, Deutschland.
authors.forename: A
authors.initials: A
authors.lastname: Kramer
authors.affiliation: Klinik für Allgemein-, Viszeral- und Thoraxchirurgie, Marienhospital Stuttgart, Vinzenz von Paul Kliniken, Böheimstr. 39, 70199, Stuttgart, Deutschland.
authors.forename: M
authors.initials: M
authors.lastname: Schäffer
mesh_terms: D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D003107:Colorectal Surgery; D024901:Drug Resistance, Multiple, Bacterial; D013293:Enterococcus faecalis / Q000187:drug effects / Q000472:pathogenicity*; D016984:Enterococcus faecium / Q000187:drug effects / Q000472:pathogenicity*; D016908:Gram-Positive Bacterial Infections / Q000175:diagnosis* / Q000188:drug therapy / Q000382:microbiology* / Q000517:prevention & control; D006801:Humans; D010538:Peritonitis / Q000175:diagnosis* / Q000188:drug therapy / Q000382:microbiology / Q000517:prevention & control; D012086:Reoperation; D012307:Risk Factors; D013530:Surgical Wound Infection / Q000175:diagnosis* / Q000188:drug therapy / Q000382:microbiology* / Q000517:prevention & control; D014774:Virulence
chemical_list: D000900:Anti-Bacterial Agents
keywords: Antibiotic therapy; Colorectal surgery; Peritonitis; Prophylaxis; Surgical site infection