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Enterokokken und postoperative Wundinfektionen

Verursacher oder harmloser Kommensale?

Enterococci and surgical site infections

Causal agent or harmless commensals?

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Zusammenfassung

Hintergrund

Die Rolle der Enterokokken im Rahmen der Peritonitis und Wundinfektionen ist nicht endgültig geklärt. Zahlreiche Resistenzen reduzieren die zur Verfügung stehenden antibiotischen Optionen.

Ziel der Arbeit

Dieser Artikel gibt einen Überblick über die pathogene Bedeutung der Enterokokken und über aktuelle Empfehlungen zu Therapie und Prophylaxe. Anhand eigener Daten wird die Relevanz von Enterokokken für Wundinfektionen diskutiert.

Material und Methoden

Retrospektiv wurden alle kolorektalen Resektionen zwischen 01/ 2008 und 09/2016 erfasst. Revisionseingriffe, Wundheilungsstörungen (WHS) sowie intraabdominell oder subkutan nachgewiesene Erreger wurden ebenfalls erfasst.

Ergebnisse

Insgesamt wurden 2713 Eingriffe ausgewertet, wobei bei 28,3 % im Rahmen des Primäreingriffs eine Peritonitis bestand. Bei 587 Patienten (21,6 %) folgte eine WHS, ein Erregernachweis war in 431 Fällen (73,4 %) möglich. Enterokokken waren gehäuft bei Revisionseingriffen (58,4 %) und WHS (46,1 %) nachweisbar, E. faecalis und E. faecium etwa gleich häufig. Waren bei primärer Peritonitis intraabdominell Enterokokken nachweisbar, kam es häufiger zu WHS und häufiger zum Enterokokkennachweis subkutan. Enterokokken bei WHS fanden sich signifikant häufiger bei Linkshemikolektomien sowie bei vorbestehender Niereninsuffizienz.

Diskussion

Enterokokken werden möglicherweise durch die gängige perioperative antibiotische Therapie bzw. präoperative Prophylaxe nicht ausreichend erfasst, wodurch das WHS-Risiko durch Enterokokken ansteigt. Dies kann durch die Selektion dieser Erreger durch Anwendung von Antibiotika mit Enterokokkenlücke (z. B. Cephalosporine) begünstigt werden. Die Berücksichtigung bei der Wahl der perioperativen Antibiotikumprophylaxe, z. B. durch Zugabe von Ampicillin oder Vancomycin, könnte vorteilhaft sein.

Abstract

Background

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.

Objective

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.

Material and methods

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.

Results

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.

Conclusion

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

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Authors and Affiliations

  1. Klinik für Allgemein-, Viszeral- und Thoraxchirurgie, Marienhospital Stuttgart, Vinzenz von Paul Kliniken, Böheimstr. 39, 70199, Stuttgart, Deutschland

    J. Pochhammer & M. Schäffer

  2. Institut für Hygiene und Umweltmedizin, Universitätsmedizin Greifswald, Greifswald, Deutschland

    A. Kramer

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Correspondence to J. Pochhammer.

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J. Pochhammer, A. Kramer und M. Schäffer geben an, dass kein Interessenkonflikt besteht.

Dieser Beitrag beinhaltet keine von den Autoren durchgeführten Studien an Menschen oder Tieren.

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Pochhammer, J., Kramer, A. & Schäffer, M. Enterokokken und postoperative Wundinfektionen. Chirurg 88, 377–384 (2017). https://doi.org/10.1007/s00104-017-0388-1

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