Alternate antimicrobial therapy for vancomycin-resistant enterococci burn wound infections

Survival after a major thermal burn is precarious and fraught with difficult complications associated with hypermetabolism, gut or respiratory dysfunction, and infection. Clinicians must be cognizant of a new threat to the patient with burn injuries--the emergence of vancomycin-resistant enterococci (VRE). In an analysis of 31 clinical isolates obtained during acute burn hospitalization, an optimal antimicrobial therapy for VRE has been identified. All VRE cultures were inoculated to the MicroScan Gram-Positive Breakpoint Combo Panel #8 (Dade Microscan, Inc, Sacramento, Calif), which speciates the enterococci, provides antimicrobial susceptibility patterns (including vancomycin) and a biotype, and examines streptomycin and gentamicin synergy. Eleven (35.5%) of the 31 isolates were identified as E faecium and 20 (64.5%) as E faecalis. All isolates were susceptible to chloramphenicol and tetracycline, whereas only half were sensitive to gentamicin synergy screen. All other antimicrobials screened against VRE were either ineffective or of limited effect. Our preliminary data supports the initiation of chloramphenicol therapy when a VRE burn wound infection is encountered or suspected.