Choice of Antibiotic and Risk of Colonization With Vancomycin-Resistant <i>Enterococcus</i> Among Patients Admitted for Treatment of Community-Acquired Pneumonia

Manzella, John P.; Benenson, Ronald; Pellerin, Gene; Kellogg, James A.; Bell, Theodore; Robertson, Michelle; Pope, Doris

doi:10.1086/501735

Cited by 7 publications

(1 citation statement)

References 10 publications

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“…Similar negative findings in density of colonization have been observed among patients colonized with vancomycin-resistant enterococci who were treated with levofloxacin and ciprofloxacin [77]. In a prospective study of hospitalized patients treated with levofloxacin for community-acquired pneumonia, a lack of colonization with vancomycin-resistant enterococci was observed at day 5 or at discharge if discharge was before day 5 [78].…”

Section: Impact On Anaerobic Florasupporting

confidence: 62%

Fluoroquinolones and Anaerobes

Stein

Goldstein

2006

Clinical Infectious Diseases

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The usefulness of fluoroquinolones for the treatment of mixed aerobic and anaerobic infections has been investigated since these agents started being used in clinical practice. Newer compounds have increased in vitro activity against anaerobes, but clinically relevant susceptibility breakpoints for these bacteria have not been established. Pharmacodynamic analyses and corroboration by new data from clinical trials have enhanced our knowledge concerning the use of fluoroquinolones to treat selective anaerobic pathogens. These studies suggest that newer agents could be useful in the treatment of several types of mixed aerobic and anaerobic infections, including skin and soft-tissue, intra-abdominal, and respiratory infections. The major concerns with expanding the use of fluoroquinolones to treat anaerobic infections have been reports of increasing resistance in Bacteroides group isolates and the impact of these antibiotics on the incidence of Clostridium difficile-associated disease.

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Section: Impact On Anaerobic Florasupporting

confidence: 62%

Fluoroquinolones and Anaerobes

Stein

Goldstein

2006

Clinical Infectious Diseases

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Patient-level analysis of incident vancomycin-resistant enterococci colonization and antibiotic days of therapy

et al. 2015

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SUMMARY Vancomycin-resistant Enterococci (VRE) infections are a public health threat associated with increased patient mortality and healthcare costs. Antibiotic usage, particularly cephalosporins, has been associated with VRE colonization and VRE bloodstream infections (VRE-BSI). We examined the relationship between antimicrobial usage and incident VRE colonization at the individual patient level. Prospective, weekly surveillance was undertaken for incident VRE colonization defined by negative admission but positive surveillance swab in a medical intensive care unit over a 17 month period. Antimicrobial exposure was quantified as days of therapy (DOT) per 1,000 patient-days (DOT). Multiple logistic regression was used to analyze incident VRE colonization and antibiotic DOT, controlling for demographic and clinical covariates. Ninety six percent (1,398/1,454) of admissions were swabbed within 24 hours of ICU arrival and of the 380 patients in the ICU long enough for weekly surveillance, 83 (22%) developed incident VRE colonization. Incident colonization was associated in bivariate analysis with male gender, more prior hospital admissions, longer prior hospital stay, and use of cefepime/ceftazidime, fluconazole, azithromycin, and metronidazole (p<0.05). After controlling for demographic and clinical covariates, metronidazole was the only antibiotic independently associated with incident VRE colonization (OR 2.0, 95% CI=1.2-3.3, p<0.009). Our findings suggest that risk of incident VRE colonization differs between individual antibiotic agents and support the possibility that antimicrobial stewardship may impact VRE colonization and infection.

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Aspiration Pneumonia

2001

N Engl J Med

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Choice of Antibiotic and Risk of Colonization With Vancomycin-Resistant Enterococcus Among Patients Admitted for Treatment of Community-Acquired Pneumonia

Cited by 7 publications

References 10 publications

Fluoroquinolones and Anaerobes

Fluoroquinolones and Anaerobes

Patient-level analysis of incident vancomycin-resistant enterococci colonization and antibiotic days of therapy

Aspiration Pneumonia

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