Skip to main content
NCBI home page
Annals of Surgery logoLink to Annals of Surgery
. 1982 Jul;196(1):43–47. doi: 10.1097/00000658-198207000-00010

Enterococcal bacteremia: clinical implications and determinants of death.

R N Garrison, D E Fry, S Berberich, H C Polk Jr
PMCID: PMC1352495  PMID: 6807223

Abstract

The pathogenicity of the enterococcus remains controversial despite recognition of this organism in inflammatory exudates. A review of 114 patients with 123 bacteremic events with enterococcus from all hospital services was undertaken. A total of 46% were in the perioperative period. The clinical indications for blood culture varied, but only 19 patients had septic shock at the time. Employing three or more associated diseases as a definition, 71 patients were considered chronically ill. The primary sources of bacteremia were commonly urinary tract (22), soft tissue (17), and intra-abdominal (12). An impressive total of 48 patients had no discernible primary focus of infection. Except for the urinary tract, infections tended to be polymicrobial; 51 patients had associated synchronous or metachronous polymicrobial bacteremias. Antibiotic therapy appropriate for enterococcus did not favorably influence outcome. By chi-square analysis, patients with urinary tract and soft tissue infections had significantly better survival rates than the group as a whole, while patients with intra-abdominal sepsis, polymicrobial bacteremia, or an unknown focus of infection did statistically worse. Enterococcal bacteremia results in a high mortality (54%); its frequent identification with other facultative and anaerobic organisms may indicate that it has a synergistic role; the frequency of unexplained bacteremias stimulates speculation that primary bacteremia from the gastrointestinal tract may be a plausible explanation.

Full text

PDF
43

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Altemeier W. A., Culbertson W. R., Fullen W. D., Shook C. D. Intra-abdominal abscesses. Am J Surg. 1973 Jan;125(1):70–79. doi: 10.1016/0002-9610(73)90010-x. [DOI] [PubMed] [Google Scholar]
  2. Bayer A. S., Seidel J. S., Yoshikawa T. T., Anthony B. F., Guze L. B. Group D enterococcal meningitis. Clinical and therapeutic considerations with report of three cases and review of the literature. Arch Intern Med. 1976 Aug;136(8):883–886. doi: 10.1001/archinte.136.8.883. [DOI] [PubMed] [Google Scholar]
  3. Bourque M., Quintiliani R., Tilton R. C. Synergism of cefazolin-gentamicin against enterococci. Antimicrob Agents Chemother. 1976 Jul;10(1):157–163. doi: 10.1128/aac.10.1.157. [DOI] [PMC free article] [PubMed] [Google Scholar]
  4. Dencker H., Kamme C., Norryd C., Märdh P. A., Tylén U. Examination for aerobic and anaerobic bacteria in human portal blood collected by transumbilical catheterization. Scand J Gastroenterol. 1974;9(4):367–369. [PubMed] [Google Scholar]
  5. Dickman M. D., Farrell R., Higgs R. H., Wright L. E., Humphries T. J., Wojcik J. D., Chappelka R. Colonoscopy associated bacteremia. Surg Gynecol Obstet. 1976 Feb;142(2):173–176. [PubMed] [Google Scholar]
  6. Eade M. N., Brooke B. N. Portal bacteraemia in cases of ulcerative colitis submitted to colectomy. Lancet. 1969 May 17;1(7603):1008–1009. doi: 10.1016/s0140-6736(69)91802-9. [DOI] [PubMed] [Google Scholar]
  7. Finegold S. M., Attebery H. R., Sutter V. L. Effect of diet on human fecal flora: comparison of Japanese and American diets. Am J Clin Nutr. 1974 Dec;27(12):1456–1469. doi: 10.1093/ajcn/27.12.1456. [DOI] [PubMed] [Google Scholar]
  8. Fry D. E., Klamer T. W., Garrison R. N., Polk H. C., Jr Atypical clostridial bacteremia. Surg Gynecol Obstet. 1981 Jul;153(1):28–30. [PubMed] [Google Scholar]
  9. Kalser M. H., Cohen R., Arteaga I., Yawn E., Mayoral L., Hoffert W. R., Frazier D. Normal viral and bacterial flora of the human small and large intestine. N Engl J Med. 1966 Mar 3;274(9):500–contd. doi: 10.1056/NEJM196603032740907. [DOI] [PubMed] [Google Scholar]
  10. Kreger B. E., Craven D. E., Carling P. C., McCabe W. R. Gram-negative bacteremia. III. Reassessment of etiology, epidemiology and ecology in 612 patients. Am J Med. 1980 Mar;68(3):332–343. doi: 10.1016/0002-9343(80)90101-1. [DOI] [PubMed] [Google Scholar]
  11. Kreger B. E., Craven D. E., McCabe W. R. Gram-negative bacteremia. IV. Re-evaluation of clinical features and treatment in 612 patients. Am J Med. 1980 Mar;68(3):344–355. doi: 10.1016/0002-9343(80)90102-3. [DOI] [PubMed] [Google Scholar]
  12. LeFrock J. L., Ellis C. A., Turchik J. B., Weinstein L. Transient bacteremia associated with sigmoidoscopy. N Engl J Med. 1973 Aug 30;289(9):467–469. doi: 10.1056/NEJM197308302890908. [DOI] [PubMed] [Google Scholar]
  13. Lerner P. I., Weinstein L. Infective endocarditis in the antibiotic era. N Engl J Med. 1966 Feb 3;274(5):259–contd. doi: 10.1056/NEJM196602032740506. [DOI] [PubMed] [Google Scholar]
  14. Liu Y. K. Phagocytic capacity of reticuloendothelial system in alcoholics. J Reticuloendothel Soc. 1979 Jun;25(6):605–613. [PubMed] [Google Scholar]
  15. Lorber B., Swenson R. M. The bacteriology of intra-abdominal infections. Surg Clin North Am. 1975 Dec;55(6):1349–1354. doi: 10.1016/s0039-6109(16)40792-9. [DOI] [PubMed] [Google Scholar]
  16. Moellering R. C., Jr, Wennersten C., Weinstein A. J. Penicillin-tobramycin synergism against enterococci: a comparison with penicillin and gentamicin. Antimicrob Agents Chemother. 1973 Apr;3(4):526–529. doi: 10.1128/aac.3.4.526. [DOI] [PMC free article] [PubMed] [Google Scholar]
  17. ORLOFF M. J., PESKIN G. W., ELLIS H. L. A bacteriologic study of human portal blood: implications regarding hepatic ischemia in man. Ann Surg. 1958 Nov;148(5):738–746. doi: 10.1097/00000658-195811000-00003. [DOI] [PMC free article] [PubMed] [Google Scholar]
  18. Onderdonk A. B., Bartlett J. G., Louie T., Sullivan-Seigler N., Gorbach S. L. Microbial synergy in experimental intra-abdominal abscess. Infect Immun. 1976 Jan;13(1):22–26. doi: 10.1128/iai.13.1.22-26.1976. [DOI] [PMC free article] [PubMed] [Google Scholar]
  19. Onderdonk A. B., Weinstein W. M., Sullivan N. M., Bartlett J. G., Gorbach S. L. Experimental intra-abdominal abscesses in rats: quantitative bacteriology of infected animals. Infect Immun. 1974 Dec;10(6):1256–1259. doi: 10.1128/iai.10.6.1256-1259.1974. [DOI] [PMC free article] [PubMed] [Google Scholar]
  20. SCHATTEN W. E., DESPREZ J. D., HOLDEN W. D. A bacteriologic study of portal-vein blood in man. AMA Arch Surg. 1955 Sep;71(3):404–409. doi: 10.1001/archsurg.1955.01270150098011. [DOI] [PubMed] [Google Scholar]
  21. Saba T. M., Di Luzio N. R. Involvement of the opsonic system in starvation induced depression of the reticuloendothelial system. Proc Soc Exp Biol Med. 1968 Jul;128(3):869–875. doi: 10.3181/00379727-128-33145. [DOI] [PubMed] [Google Scholar]
  22. Saba T. M. Physiology and physiopathology of the reticuloendothelial system. Arch Intern Med. 1970 Dec;126(6):1031–1052. [PubMed] [Google Scholar]
  23. Shlaes D. M., Levy J., Wolinsky E. Enterococcal bacteremia without endocarditis. Arch Intern Med. 1981 Apr;141(5):578–581. [PubMed] [Google Scholar]
  24. Stone H. H., Kolb L. D., Currie C. A., Geheber C. E., Cuzzell J. Z. Candida sepsis: pathogenesis and principles of treatments. Ann Surg. 1974 May;179(5):697–711. doi: 10.1097/00000658-197405000-00024. [DOI] [PMC free article] [PubMed] [Google Scholar]
  25. Weinstein W. M., Onderdonk A. B., Bartlett J. G., Gorbach S. L. Experimental intra-abdominal abscesses in rats: development of an experimental model. Infect Immun. 1974 Dec;10(6):1250–1255. doi: 10.1128/iai.10.6.1250-1255.1974. [DOI] [PMC free article] [PubMed] [Google Scholar]

Articles from Annals of Surgery are provided here courtesy of Lippincott, Williams, and Wilkins

RESOURCES