Antibiotic-resistant enterococci and the changing face of surgical infections
M. E. de Vera and R. L. Simmons
Department of Surgery, University of Pittsburgh, Pennsylvania, USA.
BACKGROUND: Enterococci have not been thought to play an important role in
intra-abdominal infections because of their relatively low virulence.
However, this notion is changing because of the recent emergence of these
microbes as significant nosocomial pathogens. OBJECTIVES: To review the
mechanisms of antibiotic resistance of enterococci and to discuss the
significance of multidrug-resistant enterococci in surgical infections.
DATA SOURCES: Medical and basic science literature relating to enterococci.
DATA SYNTHESIS: In addition to having intrinsic resistance to a number of
antibiotics, enterococci have the ability to acquire resistant genes
through the exchange of plasmids or transposons from other bacterial
species. Moreover, enterococci have been shown to transmit these genes to
other bacterial species in turn. The extensive resistance of these
microorganisms has led to their emergence as significant nosocomial
pathogens, ranking second only to Escherichia coli in the number of
pathogenic isolates recovered from patients in intensive care units. There
has also been a marked increase in vancomycin-resistant enterococcal
infections in surgical patients in the last 5 years. Some studies associate
the prior use of vancomycin or third-generation cephalosporins with the
emergence of these strains. Overall, enterococcal infections are associated
with increased morbidity and mortality. CONCLUSIONS: In view of the marked
resistance of enterococci to antibiotics and their ability to disseminate
resistance genes, these microbes have become important pathogens.
Enterococci pose a threat to surgical patients, often causing significant
therapeutic dilemmas.
