Hostname: page-component-cd9895bd7-gbm5v Total loading time: 0 Render date: 2025-01-01T00:47:57.621Z Has data issue: false hasContentIssue false
  • English
  • Français

Failure to Develop Vancomycin-Resistant Enterococcus With Oral Vancomycin Treatment of Clostridium difficile

Published online by Cambridge University Press:  02 January 2015

Cassandra D. Salgado ,
Eve T. Giannetta  and
Barry M. Farr
Cassandra D. Salgado*
Affiliation:
Department of Medicine, East Carolina University, Greenville, North Carolina
Eve T. Giannetta
Affiliation:
University of Virginia Health System, Charlottesville, Virginia
Barry M. Farr
Affiliation:
University of Virginia Health System, Charlottesville, Virginia
*
600 Moye Blvd., Room 3E-113, Brody School of Medicine, East Carolina University, Greenville, NC 27858
Get access Rights & Permissions [Opens in a new window]

Abstract

Objective:

Oral vancomycin therapy has been a risk factor for turning culture positive for vancomycin-resistant Enterococcus (VRE). VRE colonization status was reviewed for all patients who received oral vancomycin and underwent prospective cultures.

Methods:

Data were extracted from the medical records of all patients receiving oral vancomycin between August 1995 and February 2001 regarding history, hospital course, and perirectal VRE cultures. Hospital policy required contact isolation for patients receiving oral vancomycin until colonization with VRE was excluded.

Results:

Twenty-six courses of oral vancomycin were given to 22 patients. VRE colonization status after completion of therapy was evaluated for 23 courses in 20 (91%) of these patients. None of these patients became VRE culture positive during a median follow-up of 18 days (range, 9 to 39 days), with a median duration of treatment of 10 days (range, 3 to 58 days), and with a median total dose of 6,500 mg (range, 1,250 to 29,000 mg). All patients received other antibiotics within 30 days prior to therapy with oral vancomycin, during therapy with oral vancomycin, or both; 95% had received anti-anaerobic therapy and 35% had received parenteral vancomycin.

Conclusions:

Even when other risk factors were present, no patient receiving oral vancomycin at our facility subsequently became culture positive for VRE. This suggests that oral vancomycin therapy or other antibiotic use, including anti-anaerobic therapy, may not be a significant independent risk factor for turning culture positive for VRE among patients not previously exposed to the microbe.

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 25 , Issue 5 , May 2004 , pp. 413 - 417
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2004

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1.National Nosocomial Infection Surveillance (NNIS) System. National Nosocomial Infection Surveillance (NNIS) System report: data from January 1990-May 1999, issued June 1999. Am J Infect Control 1999;27:520–532.Google Scholar
2.Ostrowsky, B, Venkataraman, L, D'Agata, E, Gold, H, DeGirolami, P, Samore, M. Vancomycin-resistant enterococci in intensive care units: high frequency of stool carriage during a non-outbreak period. Arch Intern Med 1999;159:1467–1472.CrossRefGoogle ScholarPubMed
3.Byers, K, Anglim, A, Anneski, C, et al.A hospital epidemic of vancomycin-resistant Enterococcus: risk factors and control. Infect Control Hosp Epidemiol 2001;22:140–147.Google Scholar
4.Beltrami, E, Singer, D, Fish, L, et al.Risk factors for acquisition of vancomycin-resistant enterococci among patients on a renal ward during a community hospital outbreak. Am J Infect Control 2000;28:282–285.CrossRefGoogle ScholarPubMed
5.Ostrowsky, B, Trick, W, Sohn, A, et al.Control of vancomycin-resistant Enterococcus in health care facilities in a region. N Engl J Med 2001;344:1427–1433.Google Scholar
6.Stosor, V, Peterson, L, Postelnick, M, Noskin, G. Enterococcus faecium bacteremia: does vancomycin resistance make a difference? Arch Intern Med 1998;158:522–527.CrossRefGoogle Scholar
7.Fridkin, S, Edwards, J, Courval, J, et al.The effect of vancomycin and third generation cephalosporins on prevalence of vancomycin-resistant enterococci in 126 US adult intensive care units. Ann Intern Med 2001;135:175–183.Google Scholar
8.Boyle, J, Soumakis, S, Rendo, A, et al.Epidemiologic analysis and geno-typic characterization of a nosocomial outbreak of vancomycin-resistant enterococci. J Clin Microbiol 1993;31:1280–1285.Google Scholar
9.Handwerger, S, Raucher, B, Altarac, D, et al.Nosocomial outbreak due to Enterococcus faecium highly resistant to vancomycin, penicillin, and gentamicin. Clin Infect Dis 1993;16:750–755.Google Scholar
10.Weinstein, JW, Roe, M, Towns, M, et al.Resistant enterococci: a prospective study of prevalence, incidence, and factors associated with colonization in a university hospital. Infect Control Hosp Epidemiol 1996;17:36–41.Google Scholar
11.Morris, JG Jr, Shay, DK, Hebden, JN, et al.Enterococci resistant to multiple antimicrobial agents including vancomycin: establishment of endemicity in a university medical center. Ann Intern Med 1995;123:250–259.Google Scholar
12.Rubin, LG, Tucci, V, Cercenado, E, Elipoulos, G, Isenberg, HD. Vancomycin-resistant Enterococcus faecium in hospitalized children. Infect Control Hosp Epidemiol 1992;13:700–705.CrossRefGoogle ScholarPubMed
13.Shay, DK, Maloney, SA, Montecalvo, M, et al.Epidemiology and mortality risk of vancomycin-resistant enterococcal bloodstream infections. J Infect Dis 1995;172:993–1000.Google Scholar
14.Beezhold, D, Slaughter, S, Hayden, M, et al.Skin colonization with vancomycin-resistant enterococci among hospitalized patients with bacteremia. Clin Infect Dis 1997;24:704–706.Google Scholar
15.D'Agata, E, Green, W, Schulman, G, Li, H, Tang, Y, Schaffner, W. Vancomycin-resistant enterococci among chronic hemodialysis patients: a prospective study of acquisition. Clin Infect Dis 2001;32:23–29.Google Scholar
16.Lautenbach, E, Bilker, W, Brennan, P. Enterococcal bacteremia: risk factors for vancomycin-resistance and predictors of mortality. Infect Control Hosp Epidemiol 1999;20:318–323.CrossRefGoogle ScholarPubMed
17.Newell, K, Millis, J, Arnow, P, et al.Incidence and outcome of infection by vancomycin-resistant Enterococcus following orthotopic liver transplantation. Transplantation 1998;65:439–442.Google Scholar
18.Orloff, S, Busch, A, Olyaei, A, et al.Vancomycin-resistant Enterococcus in liver transplant patients. Am J Surg 1999;177:418–422.Google Scholar
19.Papanicolaou, GA, Meyers, BR, Meyers, J, et al.Nosocomial infections with vancomycin-resistant Enterococcus faecium in liver transplant recipients: risk factors for acquisition and mortality. Clin Infect Dis 1996;23:760–766.Google Scholar
20.Peset, V, Tallon, P, Sola, C, et al.Epidemiological, microbiological, clinical, and prognostic factors of bacteremia caused by high-level vancomycin-resistant Enterococcus species. Eur J Clin Microbiol Infect Dis 2000;19:742–749.Google Scholar
21.Rao, GG, Morris, KJ, George, RC, Woodford, N. Vancomycin-resistant enterococci in a district general hospital. Lancet 1992;340:1471–1472.Google Scholar
22.Singh-Naz, N, Sleemi, A, Pikis, A, Patel, K, Campos, J. Vancomycin-resistant Enterococcus faecium colonization in children. J Clin Microbiol 1999;37:413–416.Google Scholar
23.Tokars, J, Satake, S, Rimland, D, et al.The prevalence of colonization with vancomycin-resistant Enterococcus at a Veteran's Affairs institution. Infect Control Hosp Epidemiol 1999;20:171–175.Google Scholar
24.Van der Auwera, P, Pensart, N, Korten, , Murray, B, Leclercq, R. Influence of oral glycopeptide on the fecal flora of human volunteers: selection of highly glycopeptide-resistant enterococci. J Infect Dis 1996;173:1129–1136.Google Scholar
25.Luber, AD, Jacobs, RA, Jordan, M, Guglielmo, BJ. Relative importance of oral versus intravenous vancomycin exposure to the development of vancomycin-resistant enterococci. J Infect Dis 1996;173:1292–1293.CrossRefGoogle Scholar
26.Rice, LB. Emergence of vancomycin-resistant enterococci. Emerg Infect Dis 2001;7:183–187.CrossRefGoogle ScholarPubMed
27.Recommendations for preventing the spread of vancomycin resistance. MMWR 1995;44(RR-12):1–13.Google Scholar
28.Beyer, WH. Handbook of Tables for Probability and Statistics, ed. 2. Boca Raton, FL: CRC Press; 1988:226.Google Scholar
29.Bates, J, Jordens, JZ, Griffiths, DT. Farm animals as a putative reservoir for vancomycin-resistant enterococcal infection in man. J Antimicrob Chemother 1994;34:507.CrossRefGoogle ScholarPubMed
30.Bates, J, Jordens, Z, Selkon, JB. Evidence for an animal origin of vancomycin-resistant enterococci. Lancet 1993;342:290.Google Scholar
31.Calfee, DP, Giannetta, E, Farr, BM. Effective control of VRE colonization using CDC recommendations for detection and isolation. Presented at the 38th Annual Meeting of the Infectious Diseases Society of America; September 7-10, 2000; New Orleans, LA. Abstract 21:44.Google Scholar
32.Slaughter, S, Hayden, MK, Nathan, C, et al.A comparison of the effect of universal use of gloves and gowns with that of glove use alone on acquisition of vancomycin-resistant enterococci in a medical intensive care unit. Ann Intern Med 1996;125:448–456.CrossRefGoogle Scholar
33.Donskey, CJ, Chowdhry, TK, Hecker, MT, et al.Effect of antibiotic therapy on the density of vancomycin-resistant enterococci in the stool of colonized patients. N Engl J Med 2000;343:1925–1932.CrossRefGoogle Scholar
34.Lucas, GM, Lechtzin, N, Puryear, DW, Yau, LL, Flexner, CW, Moore, RD. Vancomycin-resistant and vancomycin-susceptible enterococcal bacteremia: comparison of clinical features and outcomes. Clin Infect Dis 1998;26:1127–1133.Google Scholar
35.Pegues, D, Pegues, C, Hibberd, P, Ford, D, Hooper, D. Emergence and dissemination of a highly vancomycin-resistant vanA strain of Enterococcus faecium at a large teaching hospital. J Clin Microbiol 1997;35:1565–1570.Google Scholar
36.Montecalvo, M, Horowitz, H, Gedris, C, Carbonaro, C, Tenover, FC, Issah, A. Outbreak of vancomycin-, ampicillin-, and aminoglycoside-resistant Enterococcus faecium bacteremia in an adult oncology unit. Antimicrob Agents Chemother 1994;38:1363–1367.Google Scholar
37.Bonten, M, Hayden, M, Nathan, C, et al.Epidemiology of colonization of patients and environment with vancomycin-resistant enterococci. Lancet 1996;348:1615–1619.Google Scholar
38.Dahms, RA, Johnson, EM, Statz, CL, Lee, JT, Dunn, DL, Beilman, GJ. Third-generation cephalosporins and vancomycin as risk factors for postoperative vancomycin-resistant Enterococcus infection. Arch Surg 1998;133:1343–1346.CrossRefGoogle ScholarPubMed
39.Loeb, M, Salama, S, Armstrong-Evans, M, Capretta, G, Olde, J. A case-control study to detect modifiable risk factors for colonization with vancomycin-resistant enterococci. Infect Control Hosp Epidemiol 1999;20:760–763.CrossRefGoogle ScholarPubMed
40.Moreno, F, Grota, P, Crisp, C, et al.Clinical and molecular epidemiology of vancomycin-resistant Enterococcus faecium during its emergence in a city in southern Texas. Clin Infect Dis 1995;21:1234–1237.CrossRefGoogle Scholar
41.Moulin, F, Dumontier, S, Saulnier, P, et al.Surveillance of intestinal colonization and of infection by vancomycin-resistant enterococci in hospitalized cancer patients. Clin Microbiol Infect 1996;2:192–199.Google Scholar
42.Nourse, C, Murphy, H, Byrne, C, et al.Control of a nosocomial outbreak of vancomycin resistant Enterococcus faecium in a paediatric oncology unit: risk factors for colonisation. Eur J Pediatr 1998;157:20–27.CrossRefGoogle Scholar
43.Quale, J, Landman, D, Atwood, E, et al.Experience with a hospital-wide outbreak of vancomycin-resistant enterococci. Am J Infect Control 1996;24:372–379.Google Scholar
44.Murray, B. Vancomycin-resistant enterococcal infections. N Engl J Med 2000;342:710–721.Google Scholar
45.Gerding, D. Is there a relationship between vancomycin-resistant enterococcal infection and Clostridium difficile infection? Clin Infect Dis 1997;25(suppl 2):S206–S210.Google Scholar
46.Carmeli, Y, Samore, M, Huskins, W. The association between antecedent vancomycin treatment and hospital-acquired vancomycin-resistant enterococci: a meta-analysis. Arch Intern Med 1999;159:2461–2468.Google Scholar
47.Trick, WE, Paule, SM, Cunningham, S, et al.Detection of vancomycin-resistant enterococci before and after antimicrobial therapy: use of conventional culture and polymerase chain reaction. Clin Infect Dis 2004;38:780–786.Google Scholar
48.Vollaard, EJ, Clasener, HA. Colonization resistance. Antimicrob Agents Chemother 1994;38:409–414.Google Scholar
49.D'Agata, EM, Gautam, S, Green, WK, Tang, Y. High rate of false-negative results of the rectal swab culture method in detection of gastrointestinal colonization with vancomycin-resistant enterococci. Clin Infect Dis 2002;34:167–172.Google Scholar
50.Montecalvo, MA, de Lancastre, H, Carraher, M. Natural history of colonization with vancomycin-resistant Enterococcus faecium. Infect Control Hosp Epidemiol 1995;16:680–685.Google Scholar