Surgical Research Review| Volume 125, ISSUE 2, P121-125, February 1999

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Vancomycin-resistant enterococci: Implications for surgeons

      Enterococci are the bacteria most commonly recovered from surgical site infections in the intensive care unit (ICU) and rank number 3 on the list of bacteria in all nosocomial surgical infections. Although enterococci often have been considered of low virulence in surgical patients, the prevalence and the intrinsic resistance of enterococci to most classes of antimicrobial agents make them problematic pathogens. Recently, concern has been sparked by resistance of increasing numbers of enterococcal isolates to the 2 mainstays of enterococcal therapy—ampicillin and vancomycin. Resistance appeared initially in patients in the ICU but is now seen throughout the hospital. The percent of all nosocomial enterococci that are resistant to vancomycin increased from 0.3% in 1989 to greater than 20% in 1997 (Fig 1).
      Figure thumbnail gr1
      Fig. 1Increase in proportion of vancomycin-resistant enterococci over time reported in National Nosocomial Surveillance System hospitals. N >2000 isolates for each year; P < .0001, chi-square for linear trend. Centers for Disease Control and Prevention National Nosocomial Infections Surveillance (NNIS) System.
      The percent of enterococci recovered from surgical site infections (SSIs) that are vancomycin resistant increased from 0% of isolates tested in 1989 to 14.8% in 1997 (Table I). The majority of vancomycin-resistant enterococci (VRE) are also resistant to ampicillin. This means that a significant fraction of enterococcal infections confronting the surgeon are not treatable by standard antibiotic regimens.
      Table IVancomycin susceptibility of enterococci from SSIs
       Year No. of enterococci tested Resistant (%)
      1989-1990 72 0.0
      1991-1992 121 0.8
       1993 135 4.4
       1994 453 9.0
       1995 720 8.5
       1996 800 10.9
       1997 749 14.8
      Source: Centers for Disease Control and Prevention, National Nosocomial Infections Surveillance (NNIS) System, personal communication, Scott Fridkin, MD.
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