The challenge of vancomycin-resistant enterococci: A clinical and epidemiologic study

Lam, Sing; Singer, Carol; Tucci, Victor; Morthland, Virginia H.; Pfaller, Michael A.; Isenberg, Henry D.

doi:10.1016/0196-6553(95)90038-1

Cited by 103 publications

(45 citation statements)

References 29 publications

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“…78 A further argument for the limitation of widespread use of vancomycin is the emergence of vancomycin-resistant enterococci. 79 These considerations, taken together with numerous uncontrolled series that show the ef®cacy of metronidazole to be similar to that found in controlled trials, are such that metronidazole remains the drug of choice for the treatment of acute C. dif®cile intestinal disease.…”

Section: ±46mentioning

confidence: 82%

Review article: treatment of Clostridium difficile infection

Zimmerman

Bak

Sutherland

1997

Aliment Pharmacol Ther

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Aim:A systematic review of controlled trials of therapy of Clostridium difficile intestinal infection using methodology described by the Cochrane Collaboration.Methods:Trials were identified by searching computer databases over the years 1978–1996. Trials were included if they were (a) prospective randomized, controlled trials and (b) included patients with symptomatic disease. The primary end‐point was clinical resolution of diarrhoea. Secondary end‐points were clinical relapse and stool clearance of C. difficile and C. difficile toxin.Results:Nine trials (469 patients) satisfying the inclusion criteria were identified. Two trials were placebo controlled. Six trials compared vancomycin to other antibiotics (fusidic acid, bacitracin, teicoplanin and metronidazole). For clinical resolution response rates ranged from 21 (placebo) to 100% (vancomycin). On pooling the trials, no antibiotic showed clear therapeutic superiority. Rates of clinical relapse ranged from 5 to 42%. Only one trial showed significant advantage of one antibiotic over another for prevention of relapse (teicoplanin vs. fusidic acid).Conclusion:The published data are limited, and further studies are required.

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Section: ±46mentioning

confidence: 82%

Review article: treatment of Clostridium difficile infection

Zimmerman

Bak

Sutherland

1997

Aliment Pharmacol Ther

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“…Such outbreaks may involve clonal dissemination of strains indistinguishable by pulsed-field gel electrophoresis (PFGE), not only within hospitals but also among several local hospitals (180). Multiple clones are often encountered, and sporadic isolates of unrelated strains may coexist with a predominant clone suspected of institutional spread (30,147). In hospitals in which VRE outbreaks have been detected at an early stage, cases often have been caused by a single strain (29,30,51,121,164,176).…”

Section: Geographic Distribution and Spread Within Hospitalsmentioning

confidence: 99%

“…Fortunately, rates of stool colonization with VRE among hospitalized patients far exceed infection rates with these organisms (147,176). Gastrointestinal tract colonization with VRE may persist for weeks or months, and single negative cultures may be intermixed with positive cultures over time (176).…”

Section: Geographic Distribution and Spread Within Hospitalsmentioning

confidence: 99%

“…In a recent prospective cohort study using logistic regression, VRE colonization at the time of ICU admission was found to be associated with second-and thirdgeneration cephalosporins, length of stay prior to surgical ICU admission, more than one prior ICU stay, and history of solidorgan transplantation (198). Oral vancomycin use may also be a risk factor for VRE colonization (29,147,165), and this has led to recommendations discouraging the use of this agent for the primary treatment of antibiotic-associated diarrhea (44). However, there is also recent evidence that metronidazole may not be a microbiologically innocuous alternative to oral vancomycin for the treatment of antibiotic-associated diarrhea.…”

Section: Risk Factorsmentioning

confidence: 99%

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Vancomycin-Resistant Enterococci

Çetinkaya

Falk

Mayhall

2000

Clinical Microbiology Reviews

643

344

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“…Vancomycin has no systemic adsorption and few reported side effects, except for rash (which is common). The concerns with vancomycin use are cost (USD300-USD500 for a standard 10 day course), the selection of vancomycin-resistant Enterococcus faecium strains and the need to reserve its use for MRSA (methicillin-resistant Staphylococcus aureus) infections (Lam et al, 1995;Jarvis, 1998;Garbutt et al, 1999).…”

Section: Vancomycinmentioning

confidence: 99%

Alternative treatments for Clostridium difficile disease: what really works?

McFarland

2005

Journal of Medical Microbiology

141

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Vancomycin and metronidazole have been used for treating Clostridium difficile-associated disease (CDAD) for the past 25 years, but approximately 20 % of patients develop recurrent disease. The increasing incidence of nosocomial outbreaks, cases of recurrent CDAD and other complications (toxic megacolon, ileus, sepsis) has fuelled the search for different types of treatments. As the understanding of the pathogenesis of this disease has matured, newer treatment strategies that take advantage of these mechanisms have been developed. This review will describe such treatments and examine the evidence for each strategy.

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The challenge of vancomycin-resistant enterococci: A clinical and epidemiologic study

Cited by 103 publications

References 29 publications

Review article: treatment of Clostridium difficile infection

Review article: treatment of Clostridium difficile infection

Vancomycin-Resistant Enterococci

Alternative treatments for Clostridium difficile disease: what really works?

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