ENTEROCOCCUS-FAECALIS COLONIZATION AND ENDOCARDITIS IN 5 INTENSIVE-CARE PATIENTS AS LATE SEQUELAE OF SELECTIVE DECONTAMINATION

Objective: To describe Enterococcus faecalis colonisation and endocard itis in 5 intensive care patients after treatment with selective decon tamination (SDD). Setting: Intensive care unit (ICU) in a general hosp ital. Patients: The patients were admitted to the ICU because of adult respiratory distress syndrome, polytrauma (2 patients), abdominal aor tic surgery and gastrointestinal surgery. Because these patients neede d mechanical ventilation they received systemic cefotaxime and SDD (po lymyxin E, amphotericin B and norfloxacin). Results: Colonisation with E. faecalis was documented in all patients. Intravascular catheter-re lated infection with E. faecalis occurred in 4 patients. None of the p atients received antibiotics active against, E. faecalis, because body temperature normalised after catheter removal. In the course of this ICU stay one patient died. Autopsy showed E. faecalis endocarditis. Th e other 4 patients recovered from their primary illness, but had to be readmitted after several months because of E. faecalis endocarditis. One of these patients died. One patient recovered of endocarditis, but one year later valve surgery was necessary. The other 2 patients need ed acute valve replacement. The latter 3 patients survived. Conclusion : We observed 5 patients with E. faecalis endocarditis as a late and s evere sequela of SDD during their ICU stay.