THE ROLE OF ENTEROCOCCUS IN INTRAABDOMINAL INFECTIONS - CASE-CONTROL ANALYSIS

Enterococci are frequently isolated in the setting of intraabdominal i nfection, yet their pathogenicity remains controversial. Using a case control format, we retrospectively reviewed the records of 38 patients with intraabdominal enterococcal infection and 76 patients infected w ith other organisms, matched by severity of underlying disease and ser vice. Independent risk factors for enterococcal infection, by stepwise logistic regression analysis, included hepatobiliary or pancreatic so urce, postoperative intraabdominal state, prior gastrointestinal disea ses, and nosocomial acquisition. Among patients with enterococcal infe ctions, there was no difference in outcome between those who received appropriate antibiotics and those who did not. However, 100% of entero coccal bacteremias were due to a hepatobiliary source compared with 29 % of controls (P < .05); both deaths in the enterococcal group occurre d in patients with hepatobiliary infections who were not given appropr iate therapy. We conclude that risk factors for enterococcal infection can be predicted using clinical variables. Empiric antienterococcal t herapy for hepatobiliary infections should be strongly considered, giv en the high prevalence and rate of bacteremia.