Pochhammer J, Kramer A, Schäffer M
Klinik für Allgemein-, Viszeral- und Thoraxchirurgie, Marienhospital Stuttgart, Vinzenz von Paul Kliniken, Böheimstr. 39, 70199, Stuttgart, Deutschland.
Institut für Hygiene und Umweltmedizin, Universitätsmedizin Greifswald, Greifswald, Deutschland.
Chirurg. 2017 May;88(5):377-384. doi: 10.1007/s00104-017-0388-1.
The role of enterococci in the context of peritonitis and surgical site infections (SSI) has not yet been definitively clarified but enterococci are being detected more frequently. Numerous resistances reduce the available antibiotic options.
This article gives an overview of the pathogenic importance of enterococci and of current recommendations for therapy and prophylaxis. On the basis of our own data we discuss the relevance of enterococci for SSI.
All colorectal resections carried out between January 2008 and September 2016 were retrospectively documented. Revision surgery, SSI and intra-abdominally or subcutaneously detected pathogens were recorded.
A total of 2713 interventions were evaluated with 28.3% having primary peritonitis. In 587 patients (21.6%) SSI followed, and pathogen determination was possible in 431 cases (73.4%). Enterococci were frequently found in re-operations (58.4%) and SSI (46.1%), with E. faecalis and E. faecium in approximately equal proportions. If intra-abdominal enterococci were detectable in patients with primary peritonitis, it was more common to develop SSI and enterococci were more frequently detected subcutaneously. Enterococci in SSI were found to be significantly more frequent in left hemicolectomies as well as in pre-existing renal insufficiency.
It can be inferred that enterococci are not adequately covered by commonly used perioperative antibiotic therapy or preoperative prophylaxis, which increases the risk for SSI by enterococci. This could be favored by selection of these pathogens due to the use of antibiotics without enterococcal efficacy (e. g. cephalosporins). The consideration in the choice of perioperative antibiotic prophylaxis by the additional administration of ampicillin or vancomycin could be advantageous.
肠球菌在腹膜炎及手术部位感染（SSI）中的作用尚未完全明确，但肠球菌的检出率正日益增加。多种耐药性使得可用的抗生素选择减少。
本文概述了肠球菌的致病重要性以及当前的治疗和预防建议。基于我们自己的数据，我们讨论了肠球菌与SSI的相关性。
对2008年1月至2016年9月期间进行的所有结直肠切除术进行回顾性记录。记录翻修手术、SSI以及腹腔内或皮下检测到的病原体。
共评估了2713例干预措施，其中28.3%患有原发性腹膜炎。587例患者（21.6%）随后发生了SSI，431例（73.4%）病例能够进行病原体鉴定。肠球菌在再次手术（58.4%）和SSI（46.1%）中经常被发现，粪肠球菌和屎肠球菌的比例大致相等。如果在原发性腹膜炎患者中可检测到腹腔内肠球菌，则发生SSI更为常见，且肠球菌在皮下更频繁地被检测到。在左半结肠切除术以及存在肾功能不全的情况下，SSI中肠球菌的检出率明显更高。
可以推断，常用的围手术期抗生素治疗或术前预防未能充分覆盖肠球菌，这增加了肠球菌导致SSI的风险。由于使用了对肠球菌无效的抗生素（如头孢菌素）而选择这些病原体可能会助长这种情况。在选择围手术期抗生素预防时考虑额外使用氨苄西林或万古霉素可能是有利的。
