Enterococcus faecalis colonisation and endocarditis in five intensive care patients as late sequelae of selective decontamination

Sijpkens, Yvo W.J.; Buurke, E. J.; Ulrich, C; Asselt, G. J. van

doi:10.1007/bf01701478

Cited by 18 publications

(8 citation statements)

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“…This has been suggested by others (7,10,21,25) and by us (4,5). Two placebo-controlled SDD trials, using colistin and tobramycin for topical prophylaxis, reported increased rates of infection with gram-positive cocci in patients receiving SDD (7,10).…”

Section: Discussionmentioning

confidence: 58%

“…In the study by Hammond et al, oropharyngeal colonization with methicillinresistant Staphylococcus aureus was observed more frequently in SDD-treated patients (10). In a recent report, SDD with amphotericin B, polymixin E, and norfloxacin was associated with five cases of endocarditis caused by E. faecalis (21). In contrast, others have failed to demonstrate a relationship between SDD and rectal carriage with enterococci (11).…”

Section: Discussionmentioning

confidence: 94%

“…For instance, the regimens commonly used for SDD generally do not include drugs that treat enterococci in their antimicrobial spectrum (22). An association between the use of SDD and an increase in the incidence of enterococcal infections has been reported (5,7,10,21), although others have failed to confirm this observation (11). Because of the increasing importance of enterococci as nosocomial pathogens and the problems of treating infections caused by these bacteria, we studied risk factors for the colonization of the upper respiratory tract and for infections with E. faecalis in patients treated in intensive care units (ICUs) with mechanical respirators.…”

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confidence: 99%

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Colonization and infection with Enterococcus faecalis in intensive care units: the role of antimicrobial agents

Bonten

Gaillard

Tiel

et al. 1995

Antimicrob Agents Chemother

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We studied the influences of antimicrobial agents on the colonization of the respiratory tract and infection with Enterococcus faecalis in intensive care unit (ICU) patients receiving mechanical respiration for at least 3 days. In a matched-cohort analysis, patients receiving topical antimicrobial prophylaxis (TAP) of the oropharynx and stomach with antimicrobial agents not treating E. faecalis were compared with patients not receiving TAP. Patients were matched with controls on the basis of their duration in the ICU, their use of systemic antibiotics treating and not treating E. faecalis, the administration of TAP, their APACHE II score, and surgical procedures they had undergone. In all, 276 patients were analyzed. The colonization of the oropharynx and/or trachea by E. faecalis at admission was demonstrated for 43 patients (16%). Twenty patients (9%) acquired tracheal colonization and 91 patients (40%) acquired oropharyngeal colonization with E. faecalis. In the matched-cohort analysis, 43 patients receiving TAP were matched to two controls each. TAP patients more frequently acquired tracheal colonization (15 of 43 versus 2 of 86 patients, P < 0.00001) and infections with E. faecalis (6 of 43 versus 1 of 86 patients, P < 0.01). The use of topical antibiotics not treating E. faecalis increased the risk for colonization and infection with E. faecalis.Enterococci have become a significant cause of nosocomial infections in recent years (6,17). According to the National Nosocomial Infection Surveillance Survey, which was based on studies in U.S. hospitals between 1986 and 1989, enterococci were the second most common type of microorganism recovered from nosocomial infections (6). In addition, other recent studies have demonstrated the pathogenic potential of enterococci, despite the general assumption that these microorganisms are second-rate pathogens belonging to the normal human flora (8, 9, 15). The genus Enterococcus can be divided into several species, of which Enterococcus faecalis and Enterococcus faecium are most important (19).An increasing incidence of enterococcal infection in recent decades, as reported by some, has been related to an increased use of broad-spectrum antibiotics, especially second-and thirdgeneration cephalosporins (18,20). These agents lack activity against enterococci and may provide the microorganism with a selective growth advantage. Many regimens used for the selective decontamination of the digestive tract (SDD) include a short course of administration of systemic cephalosporins (22). Furthermore, colonization and infection with enterococci might be stimulated by topical antimicrobial prophylaxis (TAP) directed against gram-negative bacteria and Staphylococcus aureus but not against enterococci. For instance, the regimens commonly used for SDD generally do not include drugs that treat enterococci in their antimicrobial spectrum (22). An association between the use of SDD and an increase in the incidence of enterococcal infections has been reported (5, 7, 10, 21), although others ...

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Section: Discussionmentioning

confidence: 58%

Section: Discussionmentioning

confidence: 94%

mentioning

confidence: 99%

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Colonization and infection with Enterococcus faecalis in intensive care units: the role of antimicrobial agents

Bonten

Gaillard

Tiel

et al. 1995

Antimicrob Agents Chemother

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“…Enterococcal infective endocarditis is nosocomial in up to 39 % of the cases (Anderson et al 2004). E. faecalis endocarditis is known to occur in patients after intensive care (Sijpkens et al 1995). The ability of E. faecalis to colonize vascular tissue is thought to be by adhesin-ligand interactions between its surface determinants and host proteins at the sites of endovascular injuries (Mohamed et al 2004;Nallapareddy and Murray 2006).…”

Section: Discussionmentioning

confidence: 99%

Myasthenia, Spondylitis and Enterococcus faecalis Endocarditis

Stöllberger

Thalmann

Finsterer

2012

Arch. Immunol. Ther. Exp.

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Parasympathomimetics, immunosuppression and plasmapheresis have considerably improved management and prognosis of myasthenia gravis. Side effects of these measures, however, may complicate the course of the disease. In a 66-year-old male with myasthenia gravis and lower back pain, blood cultures, echocardiography and magnetic resonance imaging led to the diagnosis of endocarditis and spondylodiscitis. Enterococcus faecalis grew in the blood cultures as well as on the aortic and tricuspid valve vegetations which were resected during cardiac surgery. Possible sources of the infection might be E. faecalis infections of catheter tips during a 46-day stay in the intensive care unit 11 months earlier where he had undergone plasmapheresis, hemodiafiltration and mechanical ventilation, or recurrent diarrheas since 18 months. Infection was favored by immunosuppression with glucocorticoids and azathioprine which received the patient because of myasthenia gravis and hypothyroidism. Patients with myasthenia gravis require close follow up, including infection parameters, especially when they receive immunosuppressive therapy and when microorganisms known to cause endocarditis, are identified.

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“…Because SDD is not active against resistant Gram-positive bacteria, it may promote colonization with bacteria such as S. Aureus , and E. faecalis and it can lead to infections with these bacteria in critically ill patients [90–92]. Patients' illness causes conversion of carriage of normal to abnormal flora.…”

Section: Discussionmentioning

confidence: 99%

Selective Decontamination of the Digestive Tract Reduces Pneumonia and Mortality

Haas

Schultz

2010

Critical Care Research and Practice

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Selective decontamination of the digestive tract (SDD) has been subject of numerous randomized controlled trials in critically ill patients. Almost all clinical trials showed SDD to prevent pneumonia. Nevertheless, SDD has remained a controversial strategy. One reason for why clinicians remained reluctant to implement SDD into daily practice could be that mortality was reduced in only 2 trials. Another reason could be the heterogeneity of trials of SDD. Indeed, many different prophylactic antimicrobial regimes were tested, and dissimilar diagnostic criteria for pneumonia were applied amongst the trials. This heterogeneity impeded interpretation and comparison of trial results. Two other hampering factors for implementation of SDD have been concerns over the risk of antimicrobial resistance and fear for escalation of costs associated with the use of prophylactic antimicrobials. This paper describes the concept of SDD, summarizes the results of published trials of SDD in mixed medical-surgical intensive care units, and rationalizes the risk of antimicrobial resistance and rise of costs associated with this potentially life-saving preventive strategy.

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Enterococcus faecalis colonisation and endocarditis in five intensive care patients as late sequelae of selective decontamination

Abstract: We observed 5 patients with E. faecalis endocarditis as a late and severe sequela of SDD during their ICU stay.

Cited by 18 publications

References 16 publications

Colonization and infection with Enterococcus faecalis in intensive care units: the role of antimicrobial agents

Colonization and infection with Enterococcus faecalis in intensive care units: the role of antimicrobial agents

Myasthenia, Spondylitis and Enterococcus faecalis Endocarditis

Selective Decontamination of the Digestive Tract Reduces Pneumonia and Mortality

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