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Previous Volume 343:1925-1932 December 28, 2000 Number 26 Next

	Full Text PDF Editorial by Wenzel, R. P. Add to Personal Archive Add to Citation Manager Notify a Friend E-mail When Cited PubMed Citation

ABSTRACT

Background Colonization and infection with vancomycin-resistant enterococci have been associated with exposure to antibiotics that are active against anaerobes. In mice that have intestinal colonization with vancomycin-resistant enterococci, these agents promote high-density colonization, whereas antibiotics with minimal antianaerobic activity do not.

Methods We conducted a seven-month prospective study of 51 patients who were colonized with vancomycin-resistant enterococci, as evidenced by the presence of the bacteria in stool. We examined the density of vancomycin-resistant enterococci in stool during and after therapy with antibiotic regimens and compared the effect on this density of antianaerobic agents and agents with minimal antianaerobic activity. In a subgroup of 10 patients, cultures of environmental specimens (e.g., from bedding and clothing) were obtained.

Results During treatment with 40 of 42 antianaerobic-antibiotic regimens (95 percent), high-density colonization with vancomycin-resistant enterococci was maintained (mean [±SD] number of organisms, 7.8± 1.5 log per gram of stool). The density of colonization decreased after these regimens were discontinued. Among patients who had not received antianaerobic antibiotics for at least one week, 10 of 13 patients who began such regimens had an increase in the number of organisms of more than 1.0 log per gram (mean increase, 2.2 log per gram), whereas among 10 patients who began regimens of antibiotics with minimal antianaerobic activity, there was a mean decrease in the number of enterococci of 0.6 log per gram (P= 0.006 for the difference between groups). When the density of vancomycin-resistant enterococci in stool was at least 4 log per gram, 10 of 12 sets of cultures of environmental specimens had at least one positive sample, as compared with 1 of 9 sets from patients with a mean number of organisms in stool of less than 4 log per gram (P=0.002).

Conclusions For patients with vancomycin-resistant enterococci in stool, treatment with antianaerobic antibiotics promotes high-density colonization. Limiting the use of such agents in these patients may help decrease the spread of vancomycin-resistant enterococci.

Source Information

From the Infectious Diseases Section (C.J.D., A.M.H., R.A.H.-T., R.A.B.) and the Medical Service (L.B.R.), Louis Stokes Cleveland Veterans Affairs Medical Center; the Division of Infectious Diseases (T.K.C.) and the Department of Epidemiology (C.C.W.), Case Western Reserve University; the Division of Infectious Diseases, MetroHealth Medical Center (M.T.H., J.A.H.); and the Division of Pediatric Infectious Diseases, Rainbow Babies and Children's Hospital (C.K.H.) — all in Cleveland.

Address reprint requests to Dr. Donskey at the Louis Stokes Cleveland Veterans Affairs Medical Center, Infectious Diseases Section 1110 (W), 10701 East Blvd., Cleveland, OH 44106, or at curtisd123{at}yahoo.com.

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