MULTIDRUG-RESISTANT ENTEROCOCCI - A THREAT TO THE SURGICAL PATIENT

The enterococcus has become an important nosocomial pathogen, reported by the National Nosocomial Infections Surveillance System as the thir d most common pathogen associated with bloodstream infections and the second most commonly isolated pathogen overall, It is now more frequen tly recognized as a cause of superinfection in the surgical patient, a s the possible result of the frequent use of ineffective antimicrobial s for prophylaxis and treatment, Both of these findings are due, in pa rt, to the intrinsic antimicrobial resistance of the enterococci, Of g reater concern is the ready ability of this organism to acquire resist ance traits, During the past 5 years, the appearance and rapid dissemi nation of strains with high-level resistance to vancomycin, ampicillin , gentamicin, and streptomycin have been reported; in some cases, no e ffective antimicrobial therapy was available to patients infected with these strains, Enterococci, in addition to their intrinsic and acquir ed tolerance to beta-lactams, have acquired the ability to inactivate penicillin and ampicillin via beta-lactamase production, Prompt recogn ition of such multiresistant enterococci, the implementation of effect ive infection control precautions, and rational use of antimicrobials may limit or even prevent the spread of such strains in the hospital s etting.