Lack of Increased Colonization with Vancomycin-Resistant Enterococci during Preferential Use of Vancomycin for Treatment during an Outbreak of Healthcare-Associated Clostridium difficile Infection

2010 ◽  
Vol 31 (7) ◽  
pp. 710-715 ◽  
Author(s):  
Mark Miller ◽  
Lisa Bernard ◽  
Melissa Thompson ◽  
Daniel Grima ◽  
Jocelyne Pepin
Keyword(s):  
Clostridium Difficile ◽  
Oral Vancomycin ◽  
Outbreak Period ◽  
Vancomycin Resistant Enterococci ◽  
Period 2 ◽  
Jewish General Hospital ◽  
Vancomycin Resistant ◽  
Healthcare Associated ◽  
Vancomycin Treatment ◽  
Oral Metronidazole

Objective.To assess whether use of oral vancomycin for treatment during an outbreak of Clostridium difficile infection (CDI) was associated with increased rates of colonization with vancomycin-resistant enterococci (VRE)..Design.A retrospective analysis of hospital databases.Setting.The Jewish General Hospital in Montreal, Quebec, Canada.Methods.We collected data regarding VRE colonization and CDI from November 1, 2000, through September 30, 2007, during which policies of preferential oral metronidazole or vancomycin treatment were implemented to control an outbreak of CDI. Four periods were considered: period 1, the preoutbreak period when metronidazole was used; period 2, the CDI outbreak period when metronidazole was used; period 3, the postoutbreak period when vancomycin was used; and period 4, the postoutbreak period when metronidazole was used.Results.A total of 2,412 cases of CDI and 425 cases of VRE colonization were identified. The rate of CDI increased significantly during period 2 and decreased to preoutbreak levels during period 3. The rate of VRE also increased during period 2 and decreased during the first 18 months of period 3. A clonal outbreak of cases of VRE (VanA) colonization was observed toward the end of period 3 and into period 4. Excluding the period of the clonal outbreak, there was a strong correlation between the number of cases of CDI and VRE colonization (r = 0.736; P = .001) and a negative association between VRE colonization and vancomycin use (r = —0.765; P = .04).Conclusions.Increased vancomycin use was not associated with an increase in VRE colonization over a 2-year period. Restriction of vancomycin use during CDI outbreaks because of the fear of increasing VRE colonization may not be warranted.

scholarly journals Both Oral Metronidazole and Oral Vancomycin Promote Persistent Overgrowth of Vancomycin-Resistant Enterococci during Treatment of Clostridium difficile-Associated Disease

2008 ◽  
Vol 52 (7) ◽  
pp. 2403-2406 ◽  
Author(s):  
Wafa N. Al-Nassir ◽  
Ajay K. Sethi ◽  
Yuejin Li ◽  
Michael J. Pultz ◽  
Michelle M. Riggs ◽  
...  
Keyword(s):  
Clostridium Difficile ◽  
Prospective Observational Study ◽  
Oral Vancomycin ◽  
The Past ◽  
Vancomycin Resistant Enterococci ◽  
Stool Samples ◽  
Vancomycin Resistant ◽  
Healthcare Associated ◽  
Vancomycin Treatment ◽  
Oral Metronidazole

ABSTRACT For treatment of mild to moderate Clostridium difficile-associated disease (CDAD), oral metronidazole has been recommended as the preferred agent, in part due to concern that vancomycin may be more likely to promote colonization by vancomycin-resistant enterococci (VRE). We performed a prospective observational study to examine the effects of oral metronidazole or vancomycin treatment of CDAD on acquisition and concentration of VRE stool colonization. Before, during, and after 90 courses of CDAD therapy, stool samples were cultured for VRE, and the concentrations were quantified. Eighty-seven subjects (97%) had received antibiotics within the past month. For 56 treatment courses in which preexisting VRE colonization was present, metronidazole (n = 37 courses) and vancomycin (n = 19 courses), each promoted persistent VRE overgrowth during therapy, and the concentration decreased significantly in both groups by ∼2 weeks after completion of treatment (P <0.049). For 34 treatment courses in which baseline cultures were negative for VRE, new detection of VRE stool colonization occurred during 3 (14%) of the 22 courses of metronidazole and 1 (8%) of the 12 courses of vancomycin (P = 1.0). These results demonstrate that both oral metronidazole and oral vancomycin promote the overgrowth of VRE during treatment of CDAD. New CDAD treatments are needed that are less likely to disrupt the intestinal microflora and promote overgrowth of healthcare-associated pathogens.

Contamination of Hospital Curtains With Healthcare-Associated Pathogens

2008 ◽  
Vol 29 (11) ◽  
pp. 1074-1076 ◽  
Author(s):  
Floyd Trillis ◽  
Elizabeth C. Eckstein ◽  
Rachel Budavich ◽  
Michael J. Pultz ◽  
Curtis J. Donskey
Keyword(s):  
Staphylococcus Aureus ◽  
Clostridium Difficile ◽  
Methicillin Resistant ◽  
Potential Source ◽  
Vancomycin Resistant Enterococci ◽  
Vancomycin Resistant ◽  
Healthcare Associated

In a culture survey, we found that 42% of hospital privacy curtains were contaminated with vancomycin-resistant enterococci, 22% with methicillin-resistant Staphylococcus aureus, and 4% with Clostridium difficile. Hand imprint cultures demonstrated that these pathogens were easily acquired on hands. Hospital curtains are a potential source for dissemination of healthcare-associated pathogens.

Skin and Environmental Contamination With Vancomycin-Resistant Enterococci in Patients Receiving Oral Metronidazole or Oral Vancomycin Treatment forClostridium difficile–Associated Disease

2009 ◽  
Vol 30 (1) ◽  
pp. 13-17 ◽  
Author(s):  
Ajay K. Sethi ◽  
Wafa N. Al-Nassir ◽  
Michelle M. Nerandzic ◽  
Curtis J. Donskey
Keyword(s):  
Fecal Incontinence ◽  
Environmental Contamination ◽  
Prospective Observational Study ◽  
Medical Center ◽  
Veterans Affairs ◽  
Vancomycin Resistant Enterococci ◽  
Before And After ◽  
Vancomycin Resistant ◽  
Vancomycin Treatment ◽  
Oral Metronidazole

Background.Oral metronidazole has been recommended for treatment of mild-to-moderateClostridium difficile–associated disease (CDAD), in part because of concern that use of vancomycin may be more likely to promote colonization and transmission of vancomycin-resistant enterococci (VRE). The objective of our study was to compare the frequency of skin and environmental VRE contamination associated with metronidazole treatment for CDAD with such frequency associated with vancomycin treatment for CDAD.Design.Prospective, observational study. This study was performed at the Cleveland Veterans Affairs Medical Center (Cleveland, OH). For patients with CDAD who had concurrent VRE colonization, stool, skin, and environmental samples were cultured for VRE before, during, and up to 3 weeks after therapy with metronidazole or vancomycin. The proportions of skin and environmental contamination were compared before and after resolution of diarrhea and during treatment with metronidazole or vancomycin.Results.Of the 34 patients, 17 were treated with vancomycin and 17 were treated with metronidazole. The proportion of environmental cultures that were positive for VRE was significantly higher during resolution of diarrhea than it was after resolution of diarrhea (38% vs 28%;P= .025), whereas the proportion of skin cultures positive was not different during and after resolution of diarrhea (78% vs 71%;P= .60). There were no differences between patients who received metronidazole and patients who received vancomycin in the proportions of skin culture results (73% vs 77%;P= .80) or environmental culture results (37% vs 32%;P= .359) that were positive for VRE. Eleven patients (32%) had chronic fecal incontinence, and 28 (82%) had incontinence at least once during their CDAD episode.Conclusions.In VRE-colonized patients with CDAD who experienced frequent fecal incontinence, skin and environmental VRE contamination was common during and after resolution of diarrhea. The frequency of VRE contamination was similar between patients treated with metronidazole and patients treated with vancomycin.

scholarly journals Impact of Clostridioides difficile Therapy on Nosocomial Acquisition of Vancomycin-Resistant Enterococci

2021 ◽  
Vol 14 (11) ◽  
pp. 1066
Author(s):  
Carlos L. Correa-Martínez ◽  
Niklas C. J. Hagemeier ◽  
Neele J. Froböse ◽  
Stefanie Kampmeier
Keyword(s):  
Specific Treatment ◽  
Pathogen Transmission ◽  
Inclusion Criteria ◽  
Oral Vancomycin ◽  
Clostridioides Difficile ◽  
Vancomycin Resistant Enterococci ◽  
Increased Risk ◽  
Vancomycin Resistant ◽  
Vancomycin Treatment ◽  
Genetic Comparison

Vancomycin is frequently used for the treatment of C. difficile infections (CDI). There are concerns that this might increase the risk of selecting vancomycin resistant enterococci (VRE). Here, we evaluated whether there is an increased risk of VRE acquisition following vancomycin for CDI specific treatment. Patients with CDI, metronidazole, or oral vancomycin treatment and without preexisting VRE were monitored for VRE acquisition. VRE isolates from patients with acquired and preexisting colonization were collected and subjected to whole genome sequencing. In total, 281 patients (median age 56 years, 54% of the male sex) presented with toxin positive C. difficile. Of them, 170 patients met the inclusion criteria, comprising 37 patients treated with metronidazole and 133 treated with oral vancomycin. In total, 14 patients meeting the inclusion criteria acquired VRE (vancomycin: n = 11; metronidazole: n = 3). Statistical analysis revealed no significant differences between both VRE acquisition rates. Genetic comparison of detected VRE isolates resulted in eight clusters of closely related genotypes comprising acquired and preexisting strains. Our results suggest that vancomycin and metronidazole likewise increase the risk of VRE acquisition. Genetic comparison indicates that VRE acquisition is a result of both antibiotic selection and pathogen transmission.

scholarly journals Comparative Effectiveness of Vancomycin vs. Metronidazole in Mild Clostridium difficile Infections, and Potential Impact on Subsequent Vancomycin-Resistant Enterococcus (VRE) Isolation

2017 ◽  
Vol 4 (suppl_1) ◽  
pp. S388-S388
Author(s):  
Ilan Youngster ◽  
Zipora Lazarovitch ◽  
Marina Bondorenco ◽  
Betlehem Mengesha ◽  
Limor Toledano ◽  
...  
Keyword(s):  
Clostridium Difficile ◽  
Cox Regression ◽  
Prediction Score ◽  
Vancomycin Resistant Enterococcus ◽  
Oral Vancomycin ◽  
Individual Patient Level ◽  
Patient Level ◽  
Vancomycin Resistant ◽  
Potential Impact ◽  
Vancomycin Treatment

Abstract Background The epidemiology and clinical characteristics of Clostridium difficile infections (CDI) have evolved dramatically in the past decade. Vancomycin is the treatment of choice for moderate to severe CDI, with superior cure rates observed in comparative trials. However, controlled comparative efficacy data pertaining to mild CDI is lacking. Furthermore, the potential impact of vancomycin treatment on subsequent Vancomycin-Resistant Enterococcus (VRE) isolation rates remains unknown at the individual patient level. Methods A Retrospective cohort analysis was executed at the Assaf Harofeh Medical Center, Israel, from 2010 to 2015. Adult patients (&gt;18 years) with a first episode of acute CDI, determined per pre-established criteria, were enrolled. The efficacy of vancomycin vs..metronidazole was evaluated in the subset of patients with mild CDI. The outcomes of patients, who received vancomycin or metronidazole (but not both), were compared by Cox regression. A prediction score was used to control for possible confounders associated with being treated with vancomycin. The independent association of oral vancomycin treatment during the acute CDI and later (up to 18 months) VRE isolation was analyzed using Cox regression. Results A total of 413 patients with CDI were included in the study. The majority were elderly (median age 75 years, range 19–120), and had extensive comorbidities (mean Charlson’s combined condition score 6.7 ± 3.4) and significant acute illness indices (35% with severe to fulminant Horn index). Among 126 patients with mild disease, no differences were observed in terms of clinical outcomes between vancomycin or metronidazole treatment. Metronidazole remained non-inferior even after incorporating a prediction score to control for confounders associated with being a “vancomycin case”. Ten patients had new post-CDI VRE isolation. In multivariable analysis, oral vancomycin treatment during the acute CDI was the strongest independent predictor for later isolation of VRE (aOR=6.7, P = 0.04). Conclusion Our study suggests that metronidazole should remain the recommended treatment of choice for mild CDI, due to clinical non-inferiority and an apparent association between vancomycin therapy and subsequent VRE isolation on an individual patient level analysis. Disclosures All authors: No reported disclosures.

scholarly journals Effect of Fidaxomicin versus Vancomycin on Susceptibility to Intestinal Colonization with Vancomycin-Resistant Enterococci and Klebsiella pneumoniae in Mice

2016 ◽  
Vol 60 (7) ◽  
pp. 3988-3993 ◽  
Author(s):  
Abhishek Deshpande ◽  
Kelly Hurless ◽  
Jennifer L. Cadnum ◽  
Laurent Chesnel ◽  
Lihong Gao ◽  
...  
Keyword(s):  
Klebsiella Pneumoniae ◽  
Intestinal Microbiota ◽  
Deep Sequencing ◽  
Sequencing Analysis ◽  
Oral Vancomycin ◽  
Content Type ◽  
Vancomycin Resistant Enterococci ◽  
Vancomycin Resistant ◽  
The Impact ◽  
Vancomycin Treatment

ABSTRACTThe use of oral vancomycin or metronidazole for treatment ofClostridium difficileinfection (CDI) may promote colonization by health care-associated pathogens due to disruption of the intestinal microbiota. Because the macrocyclic antibiotic fidaxomicin causes less alteration of the intestinal microbiota than vancomycin, we hypothesized that it would not lead to a loss of colonization resistance to vancomycin-resistant enterococci (VRE) and extended-spectrum-β-lactamase-producingKlebsiella pneumoniae(ESBL-Kp). Mice (8 per group) received orogastric saline, vancomycin, or fidaxomicin daily for 5 days at doses resulting in stool concentrations in mice similar to those measured in humans. The mice were challenged with 105CFU of orogastric VRE or ESBL-Kp on day 2 of treatment and concentrations of the pathogens in stool were monitored. The impact of drug exposure on the microbiome was measured by cultures, real-time PCR for selected anaerobic bacteria, and deep sequencing. In comparison to saline controls, oral vancomycin promoted establishment of high-density colonization by VRE and ESBL-Kp in stool (8 to 10 log10CFU/g;P< 0.001), whereas fidaxomicin did not (<4 log10CFU;P> 0.5). Vancomycin treatment resulted in significant reductions in enterococci,Bacteroidesspp., andClostridium leptum, whereas the population of aerobic and facultative Gram-negative bacilli increased; deep-sequencing analysis demonstrated suppression ofFirmicutesand expansion ofProteobacteriaduring vancomycin treatment. Fidaxomicin did not cause significant alteration of the microbiota. In summary, in contrast to vancomycin, fidaxomicin treatment caused minimal disruption of the intestinal microbiota and did not render the microbiota susceptible to VRE and ESBL-Kp colonization.

Timing and route of contamination of hospitalized patient rooms with healthcare-associated pathogens

2021 ◽  
pp. 1-6
Author(s):  
Sarah N. Redmond ◽  
Basya S. Pearlmutter ◽  
Yilen K. Ng-Wong ◽  
Heba Alhmidi ◽  
Jennifer L. Cadnum ◽  
...  
Keyword(s):  
Pathogen Detection ◽  
Veterans Affairs ◽  
Portable Equipment ◽  
Healthcare Facilities ◽  
Clostridioides Difficile ◽  
Bacteriophage Ms2 ◽  
Vancomycin Resistant Enterococci ◽  
Observational Cohort ◽  
Vancomycin Resistant ◽  
Healthcare Associated

Abstract Objective: To investigate the timing and routes of contamination of the rooms of patients newly admitted to the hospital. Design: Observational cohort study and simulations of pathogen transfer. Setting: A Veterans’ Affairs hospital. Participants: Patients newly admitted to the hospital with no known carriage of healthcare-associated pathogens. Methods: Interactions between the participants and personnel or portable equipment were observed, and cultures of high-touch surfaces, floors, bedding, and patients’ socks and skin were collected for up to 4 days. Cultures were processed for Clostridioides difficile, methicillin-resistant Staphylococcus aureus (MRSA), and vancomycin-resistant enterococci (VRE). Simulations were conducted with bacteriophage MS2 to assess plausibility of transfer from contaminated floors to high-touch surfaces and to assess the effectiveness of wearing slippers in reducing transfer. Results: Environmental cultures became positive for at least 1 pathogen in 10 (59%) of the 17 rooms, with cultures positive for MRSA, C. difficile, and VRE in the rooms of 10 (59%), 2 (12%), and 2 (12%) participants, respectively. For all 14 instances of pathogen detection, the initial site of recovery was the floor followed in a subset of patients by detection on sock bottoms, bedding, and high-touch surfaces. In simulations, wearing slippers over hospital socks dramatically reduced transfer of bacteriophage MS2 from the floor to hands and to high-touch surfaces. Conclusions: Floors may be an underappreciated source of pathogen dissemination in healthcare facilities. Simple interventions such as having patients wear slippers could potentially reduce the risk for transfer of pathogens from floors to hands and high-touch surfaces.

scholarly journals Discontinuation of Reflex Testing of Stool Samples for Vancomycin-Resistant Enterococci Resulted in Increased Prevalence

2013 ◽  
Vol 34 (8) ◽  
pp. 838-840 ◽  
Author(s):  
Mandy Bodily ◽  
Kathleen M. McMullen ◽  
Anthony J. Russo ◽  
Nupur D. Kittur ◽  
Joan Hoppe-Bauer ◽  
...  
Keyword(s):  
Cost Benefit Analysis ◽  
Hospital Costs ◽  
Cost Benefit ◽  
Benefit Analysis ◽  
Vancomycin Resistant Enterococci ◽  
Number Of Patients ◽  
Reflex Testing ◽  
Stool Samples ◽  
Vancomycin Resistant ◽  
Healthcare Associated

Discontinuation of reflex testing of stool submitted forClostridium difficiletesting for vancomycin-resistant enterococci (VRE) led to an increase in the number of patients with healthcare-associated VRE bacteremia and bacteriuria (0.21 vs 0.36 cases per 1,000 patient-days;P< .01). Cost-benefit analysis showed reflex screening and isolation of VRE reduced hospital costs.

Clostridium difficile—Associated Diarrhea, an Emerging Epidemic: Therapeutic Options

2007 ◽  
Vol 20 (4) ◽  
pp. 347-353
Author(s):  
Christopher R. Emerson
Keyword(s):  
Clostridium Difficile ◽  
Hospital Admissions ◽  
Treatment Options ◽  
Infectious Diarrhea ◽  
First Line ◽  
Oral Vancomycin ◽  
Considerable Morbidity ◽  
Clostridium Difficile Associated Diarrhea ◽  
Pharmacologic Agents ◽  
Oral Metronidazole

Clostridum difficile—associated disease (CDAD) is the leading cause of infectious diarrhea and is associated with considerable morbidity and mortality. The incidence is estimated to range from 3.4 to 8.4 cases per 1000 hospital admissions, and it has become a growing problem at many institutions. Treatment options for CDAD are limited due to a paucity of new pharmacologic agents and studies examining other potential treatments. Historically oral metronidazole and oral vancomycin have been used as first-line agents in the treating CDAD, however recent reports of treatment failure and recurrence with these agents have surfaced. These reports illustrate a need for novel pharmacologic agents and a thorough review of currently available agents that may have activity against C difficile. Available data on the treatment of CDAD were extracted and reviewed to outline the appropriate management of CDAD.

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