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Recurrence of vancomycin-resistant Enterococcus stool colonization during antibiotic therapy
Curtis J Donskey1, Claudia K Hoyen, Sarbani M Das
1Infectious Diseases Section, Louis Stokes Cleveland Department of Veterans Affairs Medical Center, Ohio 44106, USA.
Infection Control and Hospital Epidemiology
|August 21, 2002
Summary
Antibiotic therapy may trigger vancomycin-resistant Enterococcus (VRE) recurrence in patients who cleared colonization. Screening for VRE is recommended when these patients receive antibiotics.
Area of Science:
- Infectious Diseases
- Microbiology
- Clinical Medicine
Background:
- Vancomycin-resistant Enterococcus (VRE) is a significant healthcare-associated pathogen.
- VRE colonization clearance is a goal in infection control.
- Recurrence of VRE colonization after clearance poses a challenge.
Purpose of the Study:
- To investigate the association between antibiotic therapy and the recurrence of VRE stool colonization.
- To determine if antibiotic use impacts the density of recurrent VRE colonization.
- To assess the clonal relatedness of VRE strains in recurrent colonization.
Main Methods:
- A prospective cohort study was conducted over one year.
- Patients with previously cleared VRE colonization were monitored.
- Antibiotic exposure, VRE recurrence, and VRE density were assessed; pulsed-field gel electrophoresis (PFGE) was used for strain typing.
Main Results:
- Of 16 patients who cleared VRE, 13 received antibiotics.
- Eight of 13 (62%) patients on antibiotics developed recurrent high-density VRE colonization.
- PFGE analysis indicated that recurrent strains were often unrelated to the initial colonizing strain.
Conclusions:
- Antibiotic therapy is associated with recurrent high-density VRE stool colonization in patients who had previously cleared the infection.
- Vigilance and screening for VRE recurrence are crucial in patients receiving antibiotics after colonization clearance.