Postoperative enterococcal infection after treatment of complicated intra-abdominal sepsis

Sitges‐Serra, Antonio; López, María Jesús Martín; Girvent, Meritxell; Almirall, Silvia Montoto; Sancho, Juan José Alegre

doi:10.1046/j.0007-1323.2001.02023.x

Cited by 125 publications

(89 citation statements)

References 21 publications

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“…Several recent articles have attempted to better delineate the profile of patient populations at high risk of invasive enterococcal peritonitis and have suggested that empiric anti-enterococcal coverage in these patients may be beneficial [12,13]. Based on a selection of relevant articles, the present review attempts to summarise published evidence arguing in favour of empiric anti-enterococcal coverage in selected patient groups.…”

Section: Introductionmentioning

confidence: 99%

“…More recent studies have suggested that the presence of enterococci increases the infectious post-operative complication rate and even the risk of death [12,13]. For instance, Sitges-Serra et al [13] have looked at postoperative enterococcal infections after treatment of complicated intra-abdominal sepsis.…”

Section: Introductionmentioning

confidence: 99%

“…Post-operative enterococcal infections were associated with higher mortality (21% vs. 4%; P<0.001). The authors of this study concluded that empirical antibiotic therapy covering enterococci "should be contemplated in some circumstances" [13]. Table 1 summarises the different types of studies that have investigated potential adverse outcomes associated with enterococcal intra-abdominal infection.…”

Section: Introductionmentioning

confidence: 99%

“…For instance, Sitges-Serra et al [13] have looked at postoperative enterococcal infections after treatment of complicated intra-abdominal sepsis. They found a high proportion (50%; n=34) of enterococci in post-operative peritonitis.…”

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

Are there Patients with Peritonitis Who Require Empiric Therapy for Enterococcus?

Harbarth

Uçkay

2004

European Journal of Clinical Microbiology & Infectious Dise

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Enterococci are an increasingly important cause of nosocomial infections. While the clinical impact of enterococci in cases of bacteremia and super-infections in selected patient populations has been well-established, their role as primary pathogens in polymicrobial intraabdominal infections remains controversial. While it has been suggested that the presence of enterococci increases the rate of infectious post-operative complication, it has also been demonstrated that polymicrobial intra-abdominal infections involving enterococci can be treated successfully with appropriate surgical drainage and antibiotics, such as cephalosporins, that are not active against enterococci. Therefore, the question arises of whether or not antibiotic coverage against enterococci should be included in the empirical treatment of peritonitis in certain high-risk patient populations. An extensive literature review revealed some evidence arguing in favour of using empirical therapy with enterococcal coverage for intra-abdominal infections in the following cases: (i) immunocompromised patients with nosocomial, post-operative peritonitis; (ii) patients with severe sepsis of abdominal origin who have previously received cephalosporins and other broad-spectrum antibiotics selecting for Enterococcus spp.; (iii) patients with peritonitis and valvular heart disease or prosthetic intravascular material, which place them at high risk of endocarditis. The ideal therapeutic regimen for these high-risk patients remains to be determined, but empirical therapy directed against enterococci should be considered.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Are there Patients with Peritonitis Who Require Empiric Therapy for Enterococcus?

Harbarth

Uçkay

2004

European Journal of Clinical Microbiology & Infectious Dise

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“…Isolation of Enterococcus spp. is more common in patients with nosocomial intra-abdominal infections [17], and their isolation is a risk factor for treatment failure and death [61][62][63]. Inadequate empiric antimicrobial therapy is also a risk factor for treatment failure and death in patients with intra-abdominal infections [6,17,36] and is a strong predictor of mortality in critically ill patients with nosocomial pneumonia [64].…”

Section: Antimicrobial Therapy For Higher-risk Patients With Intra-abmentioning

confidence: 99%

Clinical Challenges and Unmet Needs in the Management of Complicated Intra-abdominal Infections

Mazuski

2005

Surgical Infections

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Methods: Based on a review of the literature, treatment guidelines, and expert opinion, the challenges of managing patients with complicated intra-abdominal infections are summarized using a patient stratification approach: "Lower risk" of treatment failure and death vs. "higher risk."Results: Risk factors for treatment failure and death can be grouped into several categories, including the patient's pre-existing medical comorbidities and physiological response to the infection, the extent of the intra-abdominal infection, and the presence of specific pathogenic microorganisms. These latter factors may be more useful than the Acute Physiology and Chronic Health Evaluation (APACHE) II score in evaluating specific management strategies for patients with complicated intra-abdominal infections. The principal goal of treatment in lower-risk patients is to avoid morbidity related to source control procedures and antimicrobial therapy. Limitation of the scope of source control procedures and utilization of short-duration, narrow-spectrum, low-toxicity antimicrobial regimens is advisable to avoid adverse drug reactions and selection of resistant organisms. For higher-risk patients, the goal is to develop improved management modalities, so that morbidity and mortality are reduced. The recommended approach for higher-risk patients is to identify the most appropriate source control procedure and antimicrobial therapy, as dictated by the patient's specific risk factors, and to utilize the optimal tools of critical care medicine to treat these critically ill, septic patients. The emergence of bacterial resistance also must be considered when selecting antimicrobial therapy for both low risk and high risk patients with intra-abdominal infections. Because aminoglycoside regimens are becoming less favored, and optimal therapeutic strategies have not been standardized, the use of new treatment options (e.g., tigecycline) may be valuable when managing patients with intra-abdominal infections. especially for resistant isolates.Conclusions: The management of lower-risk patients with intra-abdominal infections is distinct compared with patients at higher risk due to compromised physiological status, extent of intra-abdominal infection, or presence of nosocomial pathogens associated with higher-

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New insight into the association between bile infection and clinically relevant pancreatic fistula in patients undergoing pancreatoduodenectomy

Nakamura

Sho

Kinoshita³

et al. 2020

J Hepato Biliary Pancreat

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Despite improvements in surgical technique and postoperative management, pancreatoduodenectomy (PD) is associated with high morbidity 1-3. The most frequent causes of morbidity after PD are anastomotic insufficiencies, particularly clinically relevant postoperative pancreatic fistula (CR-POPF). In a recent case series, the reported rates of such conditions ranged from 8.9% to 29.1% 2-7. Previous studies have reported a correlation between bacterial infection and the development of a pancreatic fistula after PD 8-12. In particular, during the earlier postoperative period, most bacteria isolated from abdominal fluid can be associated with bile infection. Therefore, intraoperative bile contamination may become a concern. Although bile contamination may supply microorganisms responsible for abdominal infection, previous studies have not provided definitive conclusions regarding the contribution of

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Postoperative enterococcal infection after treatment of complicated intra-abdominal sepsis

Cited by 125 publications

References 21 publications

Are there Patients with Peritonitis Who Require Empiric Therapy for Enterococcus?

Are there Patients with Peritonitis Who Require Empiric Therapy for Enterococcus?

Clinical Challenges and Unmet Needs in the Management of Complicated Intra-abdominal Infections

New insight into the association between bile infection and clinically relevant pancreatic fistula in patients undergoing pancreatoduodenectomy

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