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Enterococcal Burn Sepsis: A Highly Lethal Complication in Severely Burned Patients

Enterococcal Burn Sepsis: A Highly Lethal Complication in Severely Burned Patients Abstract • A retrospective study was undertaken to examine the incidence and clinical significance of enterococcal bacteremia in burned patients with enterococcal burn-wound infections. During a 26-month period from 1983 to 1985, 38 patients were found to have enterococcal burn-wound infections. Twenty of these patients developed positive blood cultures for enterococcus with no other identifiable source for the bacteremia. Cases occurred sporadically during the study period without evidence of a specific epidemic. Ten patients died within ten days of the bacteremia, while nine others eventually died from other complications. Only one patient survived to discharge. Prior antibiotic therapy did not appear to increase the risk for enterococcal infection, and specific therapy against the enterococcus after the bacteremia was identified appeared to have no effect on mortality. Mortality was significantly greater for bacteremic patients than for patients with enterococcal wound infection alone or for burned patients without enterococcal infections. Although previously not considered pathogenic, enterococcal burn-wound infections should prompt aggressive therapy to prevent the development of enterococcal sepsis with its associated high mortality. (Arch Surg 1986;121:649-653) References 1. Parker MT, Ball LC: Streptococci and aerococci associated with clinical infections in man . J Med Microbiol 1976;9:275-302.Crossref 2. Feingold DS, Stagg NL, Kunz LJ: Extrarespiratory streptococcal infections . N Engl J Med 1966;275:356-361.Crossref 3. Garrison RN, Fry DE, Berberich S, et al: Enterococcal bacteremia: Clinical implication and determinants of death . Ann Surg 1982;196:43-47.Crossref 4. Dougherty SH, Flohr AB, Simmons RL: Breakthrough enterococcal septicemia in surgical patients . Arch Surg 1983;118:232-238.Crossref 5. Shales AM, Levy J, Wolinsky E: Enterococcal bacteremia without endocarditis . Arch Intern Med 1981;141:578-581.Crossref 6. Dougherty SH: Role of enterococcus in intra-abdominal sepsis . Am J Surg 1984;198:308-312.Crossref 7. Loebl EC, Marvin JA, Heck EL, et al: The method of quantitative burn wound biopsy culture and its routine use in the care of the burn patient . Am J Clin Pathol 1974;61:20-26. 8. Klimek JJ, Ajemian E, Gracewski J, et al: Enterococcal infections in a large community hospital, with emphasis on bacteremia . Am J Infect Control 1980;8:58-61.Crossref 9. Beard CH, Ribeiro CD, Jones DM: The bacteremia associated with burn surgery . Br J Surg 1975;62:638-641.Crossref 10. Larkin JM, Moylan JA: The role of prophylactic antibiotics in burn care . Am Surg 1976;42:247-250. 11. Moncrief JA, Teplitz C: Changing concepts in burn sepsis . J Trauma 1964;4:233-245.Crossref 12. Teplitz C, Davis D, Mason AD, et al: Pseudomonas burn wound sepsis: I. Pathogenesis of experimental Pseudomonas burn wound sepsis . J Surg Res 1964;4:200-216.Crossref 13. Marvin JA, Heck EL, Loebl EC, et al: Usefulness of blood cultures in confirming septic complications in burn patients: Evaluation of a new culture method . J Trauma 1975;15:657-662.Crossref 14. Pruitt BA, McManus AT: Opportunistic infections in severely burned patients . Am J Med 1984;76( (suppl) ):146-154.Crossref 15. Horvitz RA, Von Graevenitz A: A clinical study of the role of enterococci as sole agents of wound and tissue infection . Yale J Biol Med 1977;50:391-395. 16. Onderdonk AB, Bartlett JG, Louie T, et al: Microbiologic synergy in experimental intra-abdominal abscess . Infect Immunol 1976;13:22-26. 17. Munster AM: Immunologic response of trauma and burns: An overview . Am J Med 1984;76( (suppl) ):142-145.Crossref http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of Surgery American Medical Association

Enterococcal Burn Sepsis: A Highly Lethal Complication in Severely Burned Patients

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Publisher
American Medical Association
Copyright
Copyright © 1986 American Medical Association. All Rights Reserved.
ISSN
0004-0010
eISSN
1538-3644
DOI
10.1001/archsurg.1986.01400060043004
Publisher site
See Article on Publisher Site

Abstract

Abstract • A retrospective study was undertaken to examine the incidence and clinical significance of enterococcal bacteremia in burned patients with enterococcal burn-wound infections. During a 26-month period from 1983 to 1985, 38 patients were found to have enterococcal burn-wound infections. Twenty of these patients developed positive blood cultures for enterococcus with no other identifiable source for the bacteremia. Cases occurred sporadically during the study period without evidence of a specific epidemic. Ten patients died within ten days of the bacteremia, while nine others eventually died from other complications. Only one patient survived to discharge. Prior antibiotic therapy did not appear to increase the risk for enterococcal infection, and specific therapy against the enterococcus after the bacteremia was identified appeared to have no effect on mortality. Mortality was significantly greater for bacteremic patients than for patients with enterococcal wound infection alone or for burned patients without enterococcal infections. Although previously not considered pathogenic, enterococcal burn-wound infections should prompt aggressive therapy to prevent the development of enterococcal sepsis with its associated high mortality. (Arch Surg 1986;121:649-653) References 1. Parker MT, Ball LC: Streptococci and aerococci associated with clinical infections in man . J Med Microbiol 1976;9:275-302.Crossref 2. Feingold DS, Stagg NL, Kunz LJ: Extrarespiratory streptococcal infections . N Engl J Med 1966;275:356-361.Crossref 3. Garrison RN, Fry DE, Berberich S, et al: Enterococcal bacteremia: Clinical implication and determinants of death . Ann Surg 1982;196:43-47.Crossref 4. Dougherty SH, Flohr AB, Simmons RL: Breakthrough enterococcal septicemia in surgical patients . Arch Surg 1983;118:232-238.Crossref 5. Shales AM, Levy J, Wolinsky E: Enterococcal bacteremia without endocarditis . Arch Intern Med 1981;141:578-581.Crossref 6. Dougherty SH: Role of enterococcus in intra-abdominal sepsis . Am J Surg 1984;198:308-312.Crossref 7. Loebl EC, Marvin JA, Heck EL, et al: The method of quantitative burn wound biopsy culture and its routine use in the care of the burn patient . Am J Clin Pathol 1974;61:20-26. 8. Klimek JJ, Ajemian E, Gracewski J, et al: Enterococcal infections in a large community hospital, with emphasis on bacteremia . Am J Infect Control 1980;8:58-61.Crossref 9. Beard CH, Ribeiro CD, Jones DM: The bacteremia associated with burn surgery . Br J Surg 1975;62:638-641.Crossref 10. Larkin JM, Moylan JA: The role of prophylactic antibiotics in burn care . Am Surg 1976;42:247-250. 11. Moncrief JA, Teplitz C: Changing concepts in burn sepsis . J Trauma 1964;4:233-245.Crossref 12. Teplitz C, Davis D, Mason AD, et al: Pseudomonas burn wound sepsis: I. Pathogenesis of experimental Pseudomonas burn wound sepsis . J Surg Res 1964;4:200-216.Crossref 13. Marvin JA, Heck EL, Loebl EC, et al: Usefulness of blood cultures in confirming septic complications in burn patients: Evaluation of a new culture method . J Trauma 1975;15:657-662.Crossref 14. Pruitt BA, McManus AT: Opportunistic infections in severely burned patients . Am J Med 1984;76( (suppl) ):146-154.Crossref 15. Horvitz RA, Von Graevenitz A: A clinical study of the role of enterococci as sole agents of wound and tissue infection . Yale J Biol Med 1977;50:391-395. 16. Onderdonk AB, Bartlett JG, Louie T, et al: Microbiologic synergy in experimental intra-abdominal abscess . Infect Immunol 1976;13:22-26. 17. Munster AM: Immunologic response of trauma and burns: An overview . Am J Med 1984;76( (suppl) ):142-145.Crossref

Journal

Archives of SurgeryAmerican Medical Association

Published: Jun 1, 1986

References