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Enteric eradication of vancomycin-resistant Enterococcus faecium with oral bacitracin
C A O'Donovan1, P Fan-Havard, F T Tecson-Tumang
1Rutgers College of Pharmacy, Piscataway, New Jersey.
Diagnostic Microbiology and Infectious Disease
|February 1, 1994
Summary
Oral bacitracin effectively eradicates vancomycin-resistant Enterococcus faecium (VREF) from the gut. This study found bacitracin superior to vancomycin for VREF elimination in colonized patients, offering a promising alternative treatment.
Area of Science:
- Microbiology
- Infectious Diseases
- Pharmacology
Background:
- Vancomycin-resistant Enterococcus faecium (VREF) poses a significant therapeutic challenge.
- Intestinal colonization with VREF can lead to infections and facilitate nosocomial spread.
- Effective strategies for VREF eradication in colonized patients are needed.
Purpose of the Study:
- To evaluate the efficacy of oral vancomycin and bacitracin for eliminating VREF from the enteric tract.
- To compare the eradication rates of oral vancomycin versus oral bacitracin for VREF colonization.
Main Methods:
- Enterococcal isolates were tested for susceptibility to vancomycin, bacitracin, and ampicillin.
- Patients received initial oral vancomycin (125 mg q6h for 10 days).
- Patients failing vancomycin were treated with oral bacitracin (25,000 units q6h for 10 days).
Main Results:
- VREF eradication was achieved in 42% (8/19) of patients on oral vancomycin.
- VREF was eradicated in all eight patients receiving oral bacitracin (P < 0.01).
- Recurrence was observed in 25% (2/8) of bacitracin recipients.
Conclusions:
- Oral bacitracin demonstrates higher efficacy than oral vancomycin for VREF eradication.
- Bacitracin represents a potential alternative for managing VREF enteric colonization.
- Further investigation into prior vancomycin use and VREF colonization is warranted.