Enterococcal bacteremia in surgical patients
D. T. Barrall, P. R. Kenney, G. J. Slotman and K. W. Burchard
In 73 surgical patients enterococcal bacteremia was preceded by antibiotic
administration (n = 58), central venous catheters (n = 52), other-organism
bacteremia (n = 44), and gastrointestinal tract operations (n = 41).
Surgical wounds and urinary tract infections were the most frequent portal
of entry. The overall mortality was 42%. The mortality risk was
significantly greater in patients with preceding or concomitant
gram-positive bacteremia and four or more days of cephalosporin
administration prior to enterococcemia. In 21 patients who had been given
cephalosporins and who had gram-positive bacteremia, specific
antienterococcal therapy resulted in survival in five of nine patients,
compared with three of 12 who survived without therapy. Enterococcal
bacteremia in surgical patients follows antibiotic administration, central
venous catheter use, other-organism bacteremia, and intra-abdominal
operations. Preceding or concomitant gram-positive bacteremia defines a
subgroup of patients with high mortality who seem to respond to
antienterococcal therapy.
