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Antibiotics and gastrointestinal colonization by vancomycin-resistant enterococci.
1Medical Service 111(W), Louis Stokes Cleveland VA Medical Center and Case Medical School, 10701 East Boulevard, Cleveland, OH 44106, USA. louis.rice@med.va.gov
Summary
Minimizing certain antibiotics like extended-spectrum cephalosporins and ticarcillin-clavulanic acid can decrease glycopeptide-resistant enterococci (GRE) infections. Reducing anaerobic bacteria aids GRE colonization, highlighting the importance of antimicrobial stewardship.
Area of Science:
- Microbiology
- Infectious Diseases
- Antimicrobial Resistance
Background:
- Glycopeptide-resistant enterococci (GRE) pose a significant nosocomial threat.
- Certain antimicrobial agents are frequently associated with GRE colonization and infection.
Purpose of the Study:
- To investigate the role of specific antimicrobial agents in GRE colonization and infection.
- To elucidate the mechanisms by which certain antibiotics promote GRE persistence.
Main Methods:
- Analysis of clinical studies linking antibiotic use to GRE.
- Experimental mouse model of GRE gastrointestinal colonization.
- Evaluation of antimicrobial agents' activity against enterococci and competing flora.
Main Results:
- Extended-spectrum cephalosporins and ticarcillin-clavulanic acid are commonly implicated in GRE.
- Reducing anaerobic bacteria via antibiotic exposure promotes high-level GRE colonization.
- Antimicrobials secreted in bile with low anti-enterococcal activity facilitate GRE establishment.
Conclusions:
- Antimicrobial stewardship, particularly reducing use of implicated agents, can decrease GRE.
- Disruption of gut microbiota by antibiotics is a key factor in GRE persistence.
- Modifying prescribing practices is crucial for controlling GRE in healthcare settings.