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Antianaerobic Antibiotic Therapy Promotes Overgrowth of Antibiotic-Resistant, Gram-Negative Bacilli and Vancomycin-Resistant Enterococci in the Stool of Colonized Patients

Published online by Cambridge University Press:  02 January 2015

Anita Bhalla ,
Nicole J. Pultz ,
Amy J. Ray ,
Claudia K. Hoyen ,
Elizabeth C. Eckstein  and
Curtis J. Donskey
Anita Bhalla
Affiliation:
Infectious Diseases Division, University Hospitals of Cleveland, Cleveland, Ohio
Nicole J. Pultz
Affiliation:
Infectious Diseases Section, Louis Stokes Cleveland Veterans Affairs Medical Center, Cleveland, Ohio
Amy J. Ray
Affiliation:
Department of Medicine, University Hospitals of Cleveland, Cleveland, Ohio
Claudia K. Hoyen
Affiliation:
Pediatrics Department, Rainbow Babies and Childrens Hospital, Cleveland, Ohio
Elizabeth C. Eckstein
Affiliation:
Infectious Diseases Section, Louis Stokes Cleveland Veterans Affairs Medical Center, Cleveland, Ohio
Curtis J. Donskey*
Affiliation:
Infectious Diseases Section, Louis Stokes Cleveland Veterans Affairs Medical Center, Cleveland, Ohio
*
Infectious Diseases Section, Louis Stokes Cleveland Veterans Affairs Medical Center, 10701 East Boulevard, Cleveland, OH 44106
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Abstract

Background and Objective:

Antianaerobic antibiotic therapy promotes persistent high-density growth of vancomycin-resistant enterococci (VRE) in the stool of colonized patients. We tested the hypothesis that antibiotic regimens with potent antianaerobic activity promote overgrowth of coexisting antibiotic-resistant, gram-negative bacilli in the stool of VRE-colonized patients.

Design:

Eight-month prospective study examining the effect of antibiotic therapy on the stool density of gram-negative bacilli resistant to ceftazidime, ciprofloxacin, or piperacillin/tazobactam.

Setting:

A Department of Veterans Affairs medical center including an acute care hospital and nursing home.

Patients:

All VRE-colonized patients with at least 3 stool samples available for analysis.

Results:

One-hundred forty stool samples were obtained from 37 study patients. Forty-nine (61%) of 80 stool samples obtained during therapy with an antianaerobic regimen were positive for an antibiotic-resistant, gram-negative bacillus, whereas only 14 (23%) of 60 samples obtained 4 or more weeks after completion of such therapy were positive (P < .001). Twenty-four (65%) of the 37 patients had one or more stool cultures positive for a gram-negative bacillus resistant to ciprofloxacin, ceftazidime, or piperacillin/tazobactam. The density of these organisms was higher during therapy with antianaerobic regimens than in the absence of such therapy for at least 2 weeks (mean ± standard deviation, 5.6 ± 1.4 and 3.9 ± 0.71 log10 organisms/g; P < .001).

Conclusion:

Limiting the use of antianaerobic antibiotics in VRE-colonized patients may reduce the density of colonization with coexisting antibiotic-resistant, gram-negative bacilli.

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 24 , Issue 9 , September 2003 , pp. 644 - 649
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2003

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