Intraabdominal vancomycin-resistant enterococcus infections - The new threat

Goals: To determine the clinical course and outcome in patients with intraa bdominal vancomycin-resistant enterococcus infections (VRE-A) and to identi fy probable risk factors for VRE-A. Background: Vancomycin-resistant enterococcus is one of the most notable no socomial emerging pathogens, The incidence is increasing, especially in the abdominal surgery setting. Study: A comparative study of patients with VRE-A and VRE infection in othe r sites (VRE-O) who were hospitalized for over 1 year. Fisher exact test an d Student t test were used; a two-tailed p value of less than 0.05 was cons idered to be significant. Results: Of 89 nine patients with VRE, six had VRE-A, 24 had VRE-O, and 59 had VRE colonization The VRE-A group was comprised of one patient with an i noperable Klatskin tumor and biliary sepsis, one with acquired immune defic iency syndrome and an infected pancreatic pseudocyst, two with fecal perito nitis, and two with biliary sepsis after surgery for common bile duct stone s. All six patients with VRE-A had recent surgery before VRE isolation, as compared with three in the VRE-O group (p = 0.0001). Despite adequate treat ment with intravenous chloramphenicol, resulting in eradication of VRE in a ll six VRE-A cases, the mortality rate remained high at 50%. Conclusions: Vancomycin-resistant enterococcus should be recognized as an e merging nosocomial pathogen that causes potentially fatal intraabdominal in fections in the postsurgical setting. However, the impact of treatment on u ltimate outcome needs further evaluation.