DEFINITION OF THE ROLE OF ENTEROCOCCUS IN INTRAABDOMINAL INFECTION - ANALYSIS OF A PROSPECTIVE RANDOMIZED TRIAL

Background. The role of enterococcus in intraabdominal infection is co ntroversial. This study examines the contribution of enterococcus to a dverse outcome in a large intraabdominal infection trial. Methods. A r andomized prospective double-blind trial was performed to compare two different antimicrobial regimens in combination with surgical or percu taneous drainage in the treatment of complicated intraabdominal infect ions. A total of 330 valid patients was enrolled from 22 centers in No rth America. Results. In 330 valid patients, 71 had enterococcus isola ted from the initial drainage of an intraabdominal focus of infection. This finding was associated with a significantly higher treatment fai lure rate than that of patients without enterococcus (28% versus 14%, p < 0.01). In addition, only Acute Physiology and Chronic Health Evalu ation II score and presence of enterococcus were significant independe nt predictors of treatment failure when stepwise logistic regression w as performed (p < 0.01 and < 0.03). Risk factors for the presence of e nterococcus include age, Acute Physiology and Chronic Health Evaluatio n II, preinfection hospital length of stay, postoperative infections, and anatomic source of infection. There was no difference between the clinical trial treatment regimens with regard lo overall failure, fail ure associated with enterococcus, or frequency of enterococcal isolati on. Conclusions. This study is the first to report enterococcus as a p redictor of treatment failure in complicated intraabdominal infections . This trial also identifies several significant risk factors for the presence of enterococcus in such infections.