Are there Patients with Peritonitis Who Require Empiric Therapy for Enterococcus?

Harbarth, Stéphan Juergen; Uçkay, İlker

doi:10.1007/s10096-003-1078-0

Cited by 83 publications

(48 citation statements)

References 44 publications

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“…Patients at risk for enterococcal infection include those with postoperative intra-abdominal infection, those with recurrent gastrointestinal perforation, those with high APACHE II scores, and those receiving immunosuppressive medications [71]. In addition, it seems reasonable that patients with significant prior antibiotic exposure would be more likely to have Enterococcus infections and should be considered for routine empiric anti-enterococcal coverage [72]. Among the regimens described previously, imipenem/ cilastatin, ampicillin/sulbactam, piperacillin/tazobactam, and moxifloxacin provide reliable enterococcal coverage.…”

Section: Enterococcal Coveragementioning

confidence: 99%

Antimicrobial Therapy for Acute Colonic Diverticulitis

Byrnes

Mazuski

2009

Surgical Infections

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Background: Although guidelines and reviews have systematically evaluated diagnosis and surgical management of acute diverticulitis, they have focused only minimally on antibiotic selection for the treatment of this disease. We undertook a review of the literature to assess more clearly the use of specific antimicrobial agents in the treatment of patients with acute diverticulitis of the colon. Methods: A MEDLINE search was conducted to identify original research, review papers, and guidelines on the use of antimicrobial agents for the treatment of acute diverticulitis. Results:The general recommendation to use antibiotics with activity against common gram-negative and anaerobic pathogens has remained consistent. A number of single agents and combination regimens provide such activity. However, there is little evidence on which to base selection of specific antimicrobial regimens, and no regimen has demonstrated superiority. In general, episodes of diverticulitis severe enough to warrant hospitalization should be managed initially with intravenous antibiotics. Oral therapy can be used for outpatient treatment or when the patient's condition improves. There is a paucity of data regarding the optimal duration of antimicrobial therapy. Conclusions: Careful clinical studies are needed to evaluate better the antibiotic regimens for the treatment of acute diverticulitis. Until such studies are conducted, we are forced to rely on tradition, in vitro analyses, pharmacokinetic profiling, and indirect evidence from studies of complicated intra-abdominal infections to determine appropriate therapy for this disease.

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Section: Enterococcal Coveragementioning

confidence: 99%

Antimicrobial Therapy for Acute Colonic Diverticulitis

Byrnes

Mazuski

2009

Surgical Infections

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“…Routine treatment of Enterococcus spp. is not recommended for most patients with community-acquired intra-abdominal infections, with the possible exception of patients with serious valvular heart disease or prosthetic valves, who might be at risk for endocarditis in the event of enterococcal bacteremia [60].…”

Section: Antimicrobial Therapy For Higher-risk Patients With Intra-abmentioning

confidence: 99%

Clinical Challenges and Unmet Needs in the Management of Complicated Intra-abdominal Infections

Mazuski¹

2005

Surgical Infections

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Methods: Based on a review of the literature, treatment guidelines, and expert opinion, the challenges of managing patients with complicated intra-abdominal infections are summarized using a patient stratification approach: "Lower risk" of treatment failure and death vs. "higher risk."Results: Risk factors for treatment failure and death can be grouped into several categories, including the patient's pre-existing medical comorbidities and physiological response to the infection, the extent of the intra-abdominal infection, and the presence of specific pathogenic microorganisms. These latter factors may be more useful than the Acute Physiology and Chronic Health Evaluation (APACHE) II score in evaluating specific management strategies for patients with complicated intra-abdominal infections. The principal goal of treatment in lower-risk patients is to avoid morbidity related to source control procedures and antimicrobial therapy. Limitation of the scope of source control procedures and utilization of short-duration, narrow-spectrum, low-toxicity antimicrobial regimens is advisable to avoid adverse drug reactions and selection of resistant organisms. For higher-risk patients, the goal is to develop improved management modalities, so that morbidity and mortality are reduced. The recommended approach for higher-risk patients is to identify the most appropriate source control procedure and antimicrobial therapy, as dictated by the patient's specific risk factors, and to utilize the optimal tools of critical care medicine to treat these critically ill, septic patients. The emergence of bacterial resistance also must be considered when selecting antimicrobial therapy for both low risk and high risk patients with intra-abdominal infections. Because aminoglycoside regimens are becoming less favored, and optimal therapeutic strategies have not been standardized, the use of new treatment options (e.g., tigecycline) may be valuable when managing patients with intra-abdominal infections. especially for resistant isolates.Conclusions: The management of lower-risk patients with intra-abdominal infections is distinct compared with patients at higher risk due to compromised physiological status, extent of intra-abdominal infection, or presence of nosocomial pathogens associated with higher-

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“…For abdominal surgery there is 6 ongoing controversy whether a subset of multimorbid patients might benefit from enlarged 7 antibiotic prophylaxis including enterococcal coverage [6] and the relationship between 8 cephalosporin use and enhanced E. faecalis bacteraemia incidence has been published [4]. The 9 literature is sparse regarding orthoapedic infections and enterococci.…”

Section: Introductionmentioning

confidence: 99%

Enterococci in orthopaedic infections: Who is at risk getting infected?

Uçkay

Pires

Agostinho

et al. 2017

Journal of Infection

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Summary Some orthopaedic patients might be at risk for enterococcal infections and might benefit from adapted perioperative prophylaxis. MethodsWe performed a single-center cohort of adult patients with orthopaedic infections. . By multivariate analysis, the presence of diabetic foot infection (odds ratio 1.9, 95% confidence interval 1.2-2.9), and polymicrobial infection (OR 6.0, were the main predictors of enterococcal infection, while sex, age, and type of material were not. ResultsConclusions Community-acquired or nosocomial enterococcal infections in orthopaedic surgery are mostly polymicrobial, rare and very seldom attributed to a nosocomial origin.Thus, even if they are formally associated with prior cephalosporin use, we do not see a rational for changing our antibiotic prophylaxis.

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Are there Patients with Peritonitis Who Require Empiric Therapy for Enterococcus?

Cited by 83 publications

References 44 publications

Antimicrobial Therapy for Acute Colonic Diverticulitis

Antimicrobial Therapy for Acute Colonic Diverticulitis

Clinical Challenges and Unmet Needs in the Management of Complicated Intra-abdominal Infections

Enterococci in orthopaedic infections: Who is at risk getting infected?

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