'Breakthrough' enterococcal septicemia in surgical patients. 19 cases and a review of the literature
S. H. Dougherty, A. B. Flohr and R. L. Simmons
We studied 19 surgical patients with 24 postoperative episodes of
enterococcal septicemia not arising from the biliary or urinary tracts or
from infected heart valves. Fifteen episodes occurred despite the
administration of broad-spectrum antibiotics; in only one patient were
these drugs effective against enterococcus. There were 14 episodes of
enterococcemia in 11 patients following which the patient survived for at
least one week. Thirteen (93%) of those episodes were treated with either
ampicillin or drainage, or both. Five of the six long-term survivors
received ampicillin therapy. Overall mortality was 68%. The data suggest
that the enterococcus may emerge as a blood-borne pathogen in
immunodepressed, postoperative patients receiving antibiotics for other
infections of enteric origin. Antibiotic therapy specifically directed
against this organism (and surgical drainage, if necessary) may be
indicated during polymicrobial sepsis of enteric or mixed origin. If the
spectrum of antibiotics does not include enterococcus, this organism can
cause "breakthrough" sepsis, as can many other opportunistic organisms.
