'Breakthrough' enterococcal septicemia in surgical patients. 19 cases and a review of the literature

Abstract

We studied 19 surgical patients with 24 postoperative episodes of enterococcal septicemia not arising from the biliary or urinary tracts or from infected heart valves. Fifteen episodes occurred despite the administration of broad-spectrum antibiotics; in only one patient were these drugs effective against enterococcus. There were 14 episodes of enterococcemia in 11 patients following which the patient survived for at least one week. Thirteen (93%) of those episodes were treated with either ampicillin or drainage, or both. Five of the six long-term survivors received ampicillin therapy. Overall mortality was 68%. The data suggest that the enterococcus may emerge as a blood-borne pathogen in immunodepressed, postoperative patients receiving antibiotics for other infections of enteric origin. Antibiotic therapy specifically directed against this organism (and surgical drainage, if necessary) may be indicated during polymicrobial sepsis of enteric or mixed origin. If the spectrum of antibiotics does not include enterococcus, this organism can cause "breakthrough" sepsis, as can many other opportunistic organisms.