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Recurrence of Vancomycin-Resistant Enterococcus Stool Colonization During Antibiotic Therapy

Published online by Cambridge University Press:  02 January 2015

Curtis J. Donskey ,
Claudia K. Hoyen ,
Sarbani M. Das ,
Marion S. Helfand  and
Michelle T. Hecker
Curtis J. Donskey*
Affiliation:
Infectious Diseases Section, Louis Stokes Cleveland Department of Veterans Affairs Medical Center, Cleveland, Ohio
Claudia K. Hoyen
Affiliation:
Division of Infectious Diseases, Department of Pediatrics, Rainbow Babies and Children's Hospital, Cleveland, Ohio
Sarbani M. Das
Affiliation:
Infectious Diseases Section, Louis Stokes Cleveland Department of Veterans Affairs Medical Center, Cleveland, Ohio
Marion S. Helfand
Affiliation:
Infectious Diseases Section, Louis Stokes Cleveland Department of Veterans Affairs Medical Center, Cleveland, Ohio
Michelle T. Hecker
Affiliation:
Division of Infectious Diseases, MetroHealth Medical Center, Cleveland, Ohio
*
Louis Stokes Cleveland VA Medical Center, Infectious Diseases Section (111W), 10701 East Blvd., Cleveland, OH44106
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Abstract

Objective:

To test the hypothesis that antibiotic therapy may promote recurrence of vancomycin-resistant Enterococcus (VRE) stool colonization in patients who have previously had three consecutive negative stool cultures obtained at least 1 week apart.

Design:

One-year prospective cohort study examining the effect of antibiotic therapy on recurrence and density of VRE stool colonization in patients who have cleared colonization. Pulsed-field gel electrophoresis (PFGE) was performed to determine whether recurrent VRE strains were the same clone as the previous colonizing strain.

Setting:

A Department of Veterans Affairs medical center including an acute care hospital and nursing home.

Patients:

All patients with at least one stool culture positive for VRE who subsequently had three consecutive negative stool cultures obtained at least 1 week apart.

Results:

Of the 16 patients who cleared VRE colonization, 13 received antibiotic therapy during the study period. Eight (62%) of the 13 patients who received antibiotics developed recurrent high-density VRE stool colonization (range, 4.9 to 9.1 log10 colony-forming units per gram) during a course of therapy. Five patients had VRE strains available for PFGE analysis; recurrent strains were unrelated to the prior strain in 3 patients, closely related in 1 patient, and indistinguishable in 1 patient.

Conclusions:

Antibiotic therapy may be associated with recurrent high-density VRE stool colonization in many patients who have previously had three consecutive negative stool cultures. These patients should be screened for recurrent stool colonization when antibiotic therapy is administered.

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 23 , Issue 8 , August 2002 , pp. 436 - 440
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2002

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