Is there a relationship between vancomycin-resistant enterococcal infection and Clostridium difficile infection?

Area of Science:

• Infectious Diseases
• Antimicrobial Resistance
• Clinical Microbiology

Background:

• Clostridium difficile-associated diarrhea (CDAD) is a significant healthcare-associated infection.
• Vancomycin-resistant enterococcus (VRE) is a major cause of nosocomial infections.
• The interplay between CDAD treatments and VRE acquisition requires investigation.

Purpose of the Study:

• To investigate the association between vancomycin or metronidazole treatment for CDAD and the subsequent occurrence of VRE infection.
• To identify risk factors contributing to VRE infection and colonization.

Main Methods:

• A systematic review and meta-analysis of 18 case-control studies were conducted.
• Studies examining the relationship between CDAD treatments (vancomycin, metronidazole) and VRE were analyzed.
• Risk factors were assessed, including route of administration for vancomycin.

Main Results:

• Fifteen of 18 studies (83%) found a significant association between vancomycin use and VRE infection/colonization.
• Intravenous vancomycin use was a significant risk in 9/10 studies; oral vancomycin was a risk in 3/4.
• Metronidazole exposure was a significant risk in 4/5 studies, though indications were not specified.

Conclusions:

• Vancomycin treatment for CDAD is significantly associated with VRE infection and colonization, particularly intravenous administration.
• Metronidazole use for CDAD also poses a risk for VRE.
• Comprehensive antimicrobial stewardship and infection control measures are crucial to mitigate VRE risks.