Hostname: page-component-cd9895bd7-hc48f Total loading time: 0 Render date: 2024-12-23T08:43:12.940Z Has data issue: false hasContentIssue false
  • English
  • Français

Recurrence of Vancomycin-Resistant Enterococcus Stool Colonization During Antibiotic Therapy

Published online by Cambridge University Press:  02 January 2015

Curtis J. Donskey ,
Claudia K. Hoyen ,
Sarbani M. Das ,
Marion S. Helfand  and
Michelle T. Hecker
Curtis J. Donskey*
Affiliation:
Infectious Diseases Section, Louis Stokes Cleveland Department of Veterans Affairs Medical Center, Cleveland, Ohio
Claudia K. Hoyen
Affiliation:
Division of Infectious Diseases, Department of Pediatrics, Rainbow Babies and Children's Hospital, Cleveland, Ohio
Sarbani M. Das
Affiliation:
Infectious Diseases Section, Louis Stokes Cleveland Department of Veterans Affairs Medical Center, Cleveland, Ohio
Marion S. Helfand
Affiliation:
Infectious Diseases Section, Louis Stokes Cleveland Department of Veterans Affairs Medical Center, Cleveland, Ohio
Michelle T. Hecker
Affiliation:
Division of Infectious Diseases, MetroHealth Medical Center, Cleveland, Ohio
*
Louis Stokes Cleveland VA Medical Center, Infectious Diseases Section (111W), 10701 East Blvd., Cleveland, OH44106
Get access Rights & Permissions [Opens in a new window]

Abstract

Objective:

To test the hypothesis that antibiotic therapy may promote recurrence of vancomycin-resistant Enterococcus (VRE) stool colonization in patients who have previously had three consecutive negative stool cultures obtained at least 1 week apart.

Design:

One-year prospective cohort study examining the effect of antibiotic therapy on recurrence and density of VRE stool colonization in patients who have cleared colonization. Pulsed-field gel electrophoresis (PFGE) was performed to determine whether recurrent VRE strains were the same clone as the previous colonizing strain.

Setting:

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

Patients:

All patients with at least one stool culture positive for VRE who subsequently had three consecutive negative stool cultures obtained at least 1 week apart.

Results:

Of the 16 patients who cleared VRE colonization, 13 received antibiotic therapy during the study period. Eight (62%) of the 13 patients who received antibiotics developed recurrent high-density VRE stool colonization (range, 4.9 to 9.1 log10 colony-forming units per gram) during a course of therapy. Five patients had VRE strains available for PFGE analysis; recurrent strains were unrelated to the prior strain in 3 patients, closely related in 1 patient, and indistinguishable in 1 patient.

Conclusions:

Antibiotic therapy may be associated with recurrent high-density VRE stool colonization in many patients who have previously had three consecutive negative stool cultures. These patients should be screened for recurrent stool colonization when antibiotic therapy is administered.

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 23 , Issue 8 , August 2002 , pp. 436 - 440
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2002

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.Montecalvo, MA, de Lencastre, H, Carraher, M, et al. Natural history ot colonization with vancomycin-resistant Enterococcus faecium. Infect Control Hosp Epidemiol 1995;16:680–685.CrossRefGoogle Scholar
2.Hospital Infection Control Practices Advisory Committee (HICPAC). Recommendations for preventing the spread of vancomycin resistance. Infect Control Hosp Epidemiol 1995;16:105–113.CrossRefGoogle Scholar
3.Roghmann, M, Qaiyumi, S, Schwalbe, R, Morris, JG. Natural history of colonization with vancomycin-resistant Enterococcus faecium. Infect Control Hosp Epidemiol 1997;18:679–680.CrossRefGoogle ScholarPubMed
4.Lai, KK, Fontecchio, SA, Kelley, AL, Melvin, ZS, Baker, S. The epidemiology of fecal carriage of vancomycin-resistant enterococci. Infect Control Hosp Epidemiol 1997;18:762–765.Google ScholarPubMed
5.Patel, R, Allen, SL, Manahan, JM, et al. Natural history of vancomycin-resistant enterococcal colonization in liver and kidney transplant recipients. Liver Transpl 2001;7:27–31.CrossRefGoogle ScholarPubMed
6.National Committee for Clinical Laboratory Standards. Methods for Dilution Antimicrobial Susceptibility Tests for Bacteria That Grow Aerobically. Wayne, PA: National Committee for Clinical Laboratory Standards; 1993:M7–A3.Google Scholar
7.Donskey, CJ, Hanrahan, JA, Hutton, RA, Rice, LB. Effect of parenteral antibiotic administration on persistence of vancomycin-resistant Enterococcus faecium in the mouse gastrointestinal tract. J Infect Dis 1999;180:384–390.Google ScholarPubMed
8.Hoyen, CK, Rice, LB, Conte, S, et al. Use of real time pulsed-field gel electrophoresis to guide interventions during a nursery outbreak of Serratia marcescens infection. Pediatr Infect Dis J 1999;18:357–360.CrossRefGoogle ScholarPubMed
9.Tenover, FC, Arbeit, RD, Goering, RV, et al. Interpreting chromosomal DNA restriction patterns produced by pulsed-field gel electrophoresis: criteria for bacterial strain typing. J Clin Microbiol 1995;33:2233–2239.CrossRefGoogle ScholarPubMed
10.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
11.Donskey, CJ, Hanrahan, JA, Hutton, RA, Rice, LB. Effect of parenteral antibiotic administration on the establishment of colonization with vancomycin-resistant Enterococcus faecium in the mouse gastrointestinal tract. J Infect Dis 2000;18:1830–1833.CrossRefGoogle Scholar
12.Henning, KJ, Delencastre, H, Eagan, J, et al. Vancomycin-resistant Enterococcus faecium on a pediatric oncology ward: duration of stool shedding and incidence of clinical infection. Pediatr Infect Dis J 1996;15:848–854.CrossRefGoogle ScholarPubMed
13.Roghmann, MC, Qaiyumi, S, Johnson, JA, Schwalbe, R;. Morris, JG Jr. Recurrent vancomycin-resistant Enterococcus faecium bacteremia in a leukemia patient who was persistently colonized with vancomycin-resistant enterococci for two years. Clin Infect Dis 1997;24:514–515.CrossRefGoogle Scholar
14.Brennen, C, Wagener, MM, Muder, RR. Vancomycin-resistant Enterococcus faecium in a long-term care facility. J Am Geriatr Soc 1998;46:157–160.CrossRefGoogle ScholarPubMed
15.Edlund, C, Barkholt, L, Olsson-Liljequist, B, Nord, CE. Effect of vancomycin on intestinal flora of patients who previously received antimicrobial therapy. Clin Infect Dis 1997;25:729–732.CrossRefGoogle ScholarPubMed
16.Bodey, GP, Fainstein, V, Garcia, I, Rosenbacu, B, Wong, Y. Effect of broad-spectrum cephalosporins on the microbial flora of recipients. J Infect Dis 1983;148:892–897.CrossRefGoogle ScholarPubMed
17.Nord, CE, Brismar, B, Kasholm-Tengve, B, Tunevall, G. Effect of piperacillin/tazobactam therapy on intestinal microflora. Scand J Infect Dis 1992;24:209–213.CrossRefGoogle Scholar
18.Nord, CE, Heimdahl, A, Kager, L, Malmborg, AS. The impact of different antimicrobial agents on the normal gastrointestinal microflora of humans. Rev Infect Dis 1984;6(suppl):S270–S275.CrossRefGoogle ScholarPubMed