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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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      References

        • Bonten MJ
        • Hayden MK
        • Nathan C
        • et al.
        Epidemiology of colonisation of patients and environment with vancomycin-resistant enterococci.
        Lancet. 1996; 348: 1615-1619
        • Mainous MR
        • Lipsett PA
        • O'Brien M
        Enterococcal bacteremia in the surgical intensive care unit: does vancomycin resistance affect mortality?.
        Arch Surg. 1997; 132: 76-81
        • Beezhold DW
        • Slaughter S
        • Hayden MK
        • et al.
        Skin colonization with vancomycin-resistant enterococci among hospitalized patients with bacteremia.
        Clin Infect Dis. 1997; 24: 704-706
        • Papanicolaou GA
        • Meyers BR
        • Meyers J
        • et al.
        Nosocomial infections with vancomycin-resistant Enterococcus faecium in liver transplant recipients: risk factors for acquisition and mortality.
        Clin Infect Dis. 1996; 23: 760-766
        • Linden PK
        • Pasculle AW
        • Manez R
        • et al.
        Differences in outcome for patients with bacteremia due to vancomycin-resistant E. faecium or vancomycin-susceptible E. faecium.
        Clin Infect Dis. 1996; 22: 663-670
        • Murray BE
        Vancomycin-resistant enterococci.
        Am J Med. 1997; 101: 284-293
        • Davis JM
        • Huycke MM
        • Weils CL
        • et al.
        Surgical Infection Society Position on vancomycin-resistant enterococcus.
        Arch Surg. 1996; 131: 1061-1068
        • Slaughter S
        • Hayden MK
        • Nathan C
        • et al.
        A comparison of the effect of universal use of gloves and gowns with that of glove use alone on acquisition of vancomycin-resistant enterococci in a medical intensive care unit.
        Ann Intern Med. 1996; 125: 448-456
        • Goldmann DA
        • Weinstein RA
        • Wenzel RP
        • et al.
        Strategies to prevent and control the emergence and spread of antimicrobial resistant microorganisms in hospitals: a challenge to hospital leadership.
        JAMA. 1996; 275: 234-240
        • Hospital Infection Control Practices Advisory Committee
        Interim guideline for prevention and control of staphylococcal infection associated with reduced susceptibility to vancomycin.
        MMWR Morbid Mortal Wkly Rep. 1997; 46 (635-6): 62-68