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Impact of Enterococcus ssp. on mortality and morbidity of patients with perforation of the small and large bowel. Retrospective analysis on 473 patients

Abstract number: P1541

Kaffarnik M.F., Urban M., Utzolino S., Hopt U.T.

Objectives: Among other bacteria Enterococcus ssp. are frequently detected in abdominal fluid after bowel perforation, as well as after major abdominal surgergy. The commonly administered antibiotics are not or just partially effective against Enterococcus ssp. The need for a specific treatment of Enterococcus ssp. is discussed controversely. Agents that are effective ex-vivo penetrate tissue insufficiently or are very expensive. Based on this background and the growing number of vancomycine resistant Enterococci there is demand to identify patients after abdominal surgery who could benefit from therapy.

Methods: We included 473 patients with intestinal perforation. The patients were divided into three different groups, 1: Enterococcus ssp. not detected, no therapy, 2: Enterococcus ssp. detected, no therapy, and 3: Enterococcus ssp. detected, specific therapy. We compared the groups and analysed how far age, sex, immunosuppression, and detection of Enterococcus ssp. influence the course of the disease. Primary endpoint of the study was lethality. Secondary endpoints were morbidity, LOS-ICU and LOS-Hospital. The severity of the disease was assessed using the SOFA-Score (Sepsis-related Organ Failure Assessment).

Results: 90-day-mortality was significantly higher in group 3 compared with group 1 and 2 (p < 0.001, graphic 1). There was no difference between group 1 and group 2. LOS-ICU, LOS-Hospital and SOFA-score were significantly higher in group 3 than in group 1 or 2. Age was the only independent factor regarding the course of the disease.

Conclusion:Enterococcus ssp. detected in peritoneal fluid after major abdominal surgery are often due to colonisation and do not warrant specific treatment. Nevertheless, Enterococci occurring in peritoneal fluid become increasingly relevant in critically ill patients, as they can worsen the prognosis. Therefore, in critically ill and immunocompromised patients specific treatment of Enterococcus ssp. must be considered.

Graphic 1.

Graphic: Statistically significant difference between lethality in group 1 and 2 compared group 3 (30-day: n < 0.05; 60-day: n < 0.01 90-day: n < 0.001). No difference between group 1 compared with group 2 (n < 0.3).

Session Details

Date: 19/04/2008
Time: 00:00-00:00
Session name: 18th European Congress of Clinical Microbiology and Infectious Diseases
Subject:
Location: Barcelona, Spain
Presentation type:
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