What is the role of lab tests in the diagnosis of enterococcal infections?

Updated: Jun 10, 2021
  • Author: Susan L Fraser, MD; Chief Editor: John L Brusch, MD, FACP  more...
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Answer

The appropriate laboratory studies depend on the potential clinical syndrome present. Ideally, before administering empiric antibiotic therapy, obtain cultures from sites suspected to be infected, including blood, urine, peritoneal fluid, joint fluid, CSF, and/or pyogenic fluid collections in soft tissue.

Blood cultures are usually indicated in patients with possible infection who also require hospitalization. If endocarditis is suspected, obtain 3 sets of blood cultures over 1 hour or longer before administering empirical antibiotic therapy. A blood culture positive for Enterococcus species in a patient with a polymicrobial infection from an intra-abdominal source indicates the need for antimicrobial therapy, including activity against enterococci. A blood culture positive for Enterococcus species (especially if multiple cultures are positive) also warrants an evaluation for endocarditis if clinical features suggest this diagnosis. Echocardiography should be performed to help evaluate for cardiac vegetations.

Susceptibility testing is essential for all enterococcal isolates that require antimicrobial therapy.

Stool specimens, perirectal cultures that grow resistant Enterococcus, or both are the criterion standard for evaluating VRE colonization.

Multiple blood cultures that are positive for enterococci are associated with increased inpatient mortality. [30]


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