- Intra-abdominal infection with a mixture of bacteria. The Enterococcus is inherently resistant and able to
break through the usual antibiotic choice therefore it is often the only micro-organism that grows in the culture e.g. diverticulitis, cholangitis, peritonitis
- Intra-vascular infection where the Enterococcus is present at all times in the blood because it has adhered to some other structure e.g. IV device related infection or infective endocarditis
- Translocation across the bowel wall due to a bowel lesion e.g. malignancy, WARNING the patient may not be showing any other features of an infection such as a fever. Translocation can be the route which leads to the bacteria adhering to another structure, as in No.2 above.
- Intra-abdominal infections may require surgical intervention to drain the biliary tree or an abscess or
repair a perforated abdominal viscus.
- Infected IV devices need to be removed, if infective endocarditis is present, it will need prolonged courses of IV antibiotics (up to 6 weeks)
- Early bowel malignancy may be cured with surgery alone
the pieces to reveal the full picture. Keep asking “Why?”
“Why would that be there? ...Where should that be? ...Why
is it there?” These dilemmas should be what inspire doctors to make great diagnoses. Embrace it. Keep asking “Why?"