The implications of enterococci for the intensive care unit.

OBJECTIVE: To review the evidence of pathogenicity and virulence of Enterococcus spp. in the intensive care unit.

DATA SOURCES: MEDLINE search for studies and articles on Enterococcus spp.

RESULTS: Enterococcus spp. are normal commensal organisms in the alimentary tract and are traditionally considered to have relatively low virulence. However, they can cause a variety of life-threatening infections, especially in immunocompromised patients and nosocomial settings. The role of enterococci as primary pathogens in polymicrobial intra-abdominal infections remains controversial. There is enough evidence to suggest that complicated, community-acquired intra-abdominal infections involving mixed flora can be treated with surgery and non-enterococcal antibiotic cover. Recent studies have shown that enterococcal peritonitis is associated with increased mortality.

CONCLUSIONS: Although the prevalence of enterococcal infections may be low in Australian ICUs, these infections are associated with a higher prevalence of treatment failure and mortality. We therefore suggest the use of enterococcal antibiotic coverage in: immunocompromised patients with a high risk of bacteraemia (eg, liver transplant patients); patients with peritonitis and valvular heart disease or prosthetic intravascular material; patients with severe sepsis of abdominal origin who have previously received broad spectrum antibiotics; and patients with persistent intra- abdominal collection without clinical improvement.