Cecal ligation and puncture induced sepsis impairs host defense against Enterococcus faecium peritonitis

Abstract

Purpose: Multiresistant and vancomycin resistant Enterococcus faecium (VRE) can cause serious infections in hospitalized patients with various co-morbid diseases. We investigated the course of VRE peritonitis after cecal ligation and puncture (CLP)-induced sepsis and compared this to sham operated mice. Methods: Mice were subjected to CLP or sham surgery. Forty-eight hours thereafter four groups were created by subjecting mice to peritoneal injection of either VRE or saline. Results: Mice infected with VRE after CLP were severely impaired in eliminating VRE from the peritoneal cavity and distant body sites. These mice failed to mount an early inflammatory response at the primary site of VRE infection. VRE superinfection did not influence CLPinduced organ damage or polymicrobial bacterial loads. Conclusions: Sublethal polymicrobial sepsis greatly facilitates infection and dissemination of VRE. VRE does not influence the course of CLPinduced sepsis.

Enterococcus faecalis Overcomes Foreign Body-Mediated Inflammation To Establish Urinary Tract Infections

“…Further, these findings suggest that E. faecalis possesses immune evasion mechanisms that allow its survival in the face of this glucocorticoid-resistant immune response and that implant-mediated bladder inflammation, as in the case of preimplanted animals, did not alter the outcome of infection. The acute inflammatory response induced by the implant may even alter or impair the host response to bacteria, as was demonstrated for Enterococcus faecium peritonitis following treatment with turpentine or casein prior to bacterial challenge (65).…”

New Developments with Vancomycin‐Resistant Enterococci:E. faecium—Friend or Foe?

“…The approach of precolonizing the intestine with E. faecium prior to CLP provides a continuous source of E. faecium throughout the course of the study, as opposed to direct peritoneal injections that will be cleared relatively rapidly, and as such, it may more closely reflect various clinical conditions. Interestingly, the protective effects of VRE were only seen when the intestine was VRE colonized prior to CLP and were not observed when CLP was followed by intraperitoneal injection of VRE [18], perhaps because of the differences in VRE clearance and the bacterial load provided by these 2 different approaches. In a similar vein, these same authors have reported previously [18] that healthy mice rapidly clear intraperitoneally injected VRE, and that the acute phase reactants for VREcolonized mice after CLP is similar to that seen in mice injected with VRE alone.…”

“…Interestingly, the protective effects of VRE were only seen when the intestine was VRE colonized prior to CLP and were not observed when CLP was followed by intraperitoneal injection of VRE [18], perhaps because of the differences in VRE clearance and the bacterial load provided by these 2 different approaches. In a similar vein, these same authors have reported previously [18] that healthy mice rapidly clear intraperitoneally injected VRE, and that the acute phase reactants for VREcolonized mice after CLP is similar to that seen in mice injected with VRE alone. The response to CLP in the absence of E. faecium, however, is greater and more sustained.…”

“…In terms of the cell types that may underlie bacterial clearance in this model, it is probable that neutrophils and macrophages play a key role [17,18]. In this regard, the authors indicated that there were no detectable differences in the amount of neutrophils present in the peritoneum following VRE colonization and CLP.…”

“…On the basis of previous data from Leendertse et al [18] and from other laboratories, it is likely that the capacity of VRE to attenuate polymicrobial peritonitis and host inflammatory responses is related to the route of infection. The approach of precolonizing the intestine with E. faecium prior to CLP provides a continuous source of E. faecium throughout the course of the study, as opposed to direct peritoneal injections that will be cleared relatively rapidly, and as such, it may more closely reflect various clinical conditions.…”