Soft tissue and wound infections due to Enterococcus spp. among hospitalized trauma patients in a developing country

Abstract

Soft tissue and wound infections due to Enterococcus spp. are increasing worldwide with current need to understand the epidemiology of the Enterococcal infections of wounds. Hence, we have looked into the distribution of Enterococcus spp. responsible for causing wound and soft tissue infections among trauma patients, its antibiotic resistance pattern and how it affects the length of hospital stay and mortality. A laboratory cum clinical-based study was performed over a period of 3 years at a level I trauma center in New Delhi, India. Patients with Enterococcal wound and soft tissue infections were identified using the hospital data base, their incidence of soft tissue/wound infections calculated, drug resistance pattern and their possible risk factors as well as outcomes analyzed. A total of 86 non-repetitive Enterococcus spp. was isolated of which E. faecium were maximally isolated 48 (56%). High level of resistance was seen to gentamicin HLAR in all the species of Enterococcus causing infections whereas a low level resistance to vancomycin and teicoplanin was observed among the isolates. Longer hospital stay, repeated surgical procedure, prior antibiotic therapy and ICU stay were observed to associate with increased morbidity (P < 0.05) and hence, more chances of infections with VRE among the trauma patients. The overall rate of wound and soft tissue infections with Enterococcus sp. was 8.6 per 1,000 admissions during the study period. Enterococcal wound infection is much prevalent in trauma care facilities especially in the ICUs. Here, a microbiologist can act as a sentinel, help in empirical therapeutic decisions and also in preventing such infections.

Closed Incision Negative Pressure Wound Therapy in the Management of a Complex Fasciotomy Wound in a Pediatric Patient

“…Enterococcus faecalis is a known nosocomial infection that is becoming more of a worrisome entity as virulent strains become more prevalent. Risk factors for infection include exposure to previous antibiotics, repeat surgical procedures, ICU stay, and immunocompromise [9,10]. Treatment usually consists of an IV antibiotic regimen based on culture sensitivities.…”

Surgical site infections following caesarean operations at a Jordanian teaching hospital: Frequency and implicated factors

“…Similar to other studies, staphylococcal microorganisms were the predominate type of infecting pathogens 9 , 10 , and other common pathogens included enterococcal bacteria. Enterococcal infections are not only common in caesareans 12 but they are also thought to be the third most common cause of nosocomial infections globally, and special infection control measures are required in managing such infections 17 .…”

Interplay between ESKAPE Pathogens and Immunity in Skin Infections: An Overview of the Major Determinants of Virulence and Antibiotic Resistance

“…However, some species of the genus have shown clinical relevance in the last decade, such as Enterococcus faecalis and Enterococcus faecium , both involved in wound infections [ 107 , 108 , 109 ]. Additionally, Enterococcus gallinarum and Enterococcus casseliflavus/flavescens (with intrinsic resistant towards vancomycin) have also gained attention due their involvement in surgical wound infections [ 110 , 111 , 112 , 113 ].…”

“…It has been isolated in surgical site infections and diabetic foot [ 115 , 116 ]. For example, a study conducted in India showed that E. faecium was the most commonly observed Enterococcus species in traumatic skin wounds; followed by E. faecalis [ 111 ]. Similarly, another study reported that E. faecium was the main etiologic agent in skin and soft-tissue infections (SSTI) related to combat casualties [ 117 ].…”

“…Similarly, another study reported that E. faecium was the main etiologic agent in skin and soft-tissue infections (SSTI) related to combat casualties [ 117 ]. E. faecium is also involved in polymicrobial infections with E. coli [ 116 ] and E. faecalis [ 111 ]. Specifically, the association of E. faecium in diabetic foot ulcers was shown to be related with limb loss [ 116 ].…”