Antibiotic Coverage for Enterococcus faecalis in Feculent Peritonitis

Indications for Anti-enterococcal Coverage

The Infectious Diseases Society of America recommends antimicrobial therapy for enterococci when enterococci are recovered from patients with healthcare-associated intra-abdominal infections 1
Enterococci are more prevalent in healthcare-associated infections (22.3%) compared to community-acquired infections (13.9%) 2
In a retrospective study of patients with secondary peritonitis treated in ICU, Enterococci were isolated in 47.1% of all patients, making them the most prevalent bacteria among aerobic Gram-positive isolates 3

Empiric anti-enterococcal therapy is specifically recommended for patients with postoperative infections 1
The presence of Enterococcus species, particularly in polymicrobial peritonitis, has been associated with worse outcomes 3

Initial empiric anti-enterococcal therapy should be directed against Enterococcus faecalis 1
Recommended antibiotics for E. faecalis coverage include ampicillin 1
For biofilm infections, a combination of ampicillin-ceftriaxone is recommended as it effectively targets biofilm-embedded bacteria, according to Praxis Medical Insights 4

For community-acquired biliary infections, antimicrobial activity against enterococci is not required, as the pathogenicity of enterococci has not been demonstrated in this specific context 1

Failing to cover for Enterococcus in healthcare-associated infections can lead to treatment failure and worse outcomes 1, 2
Prolonged antibiotic therapy (>10 days) increases the risk of enterococcal colonization and potential superinfection with resistant strains, as noted by Praxis Medical Insights 4
Not adjusting therapy when cultures reveal Enterococcus species, especially in patients with risk factors, is a pitfall to avoid 1