Lack of Efficacy of Oral Bacitracin Plus Doxycycline for the Eradication of Stool Colonization with Vancomycin-Resistant Enterococcus faecium

In a prospective observational cohort study designed to assess the role of oral bacitracin solution plus doxycycline in the eradication of intestinal carriage of vancomycin-resistant Enterococcus faecium (VREF) in patients on a renal ward, rectal swab specimens were obtained from 15 treated and 24 c...

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Bibliographic Details
Published in:Clinical infectious diseases 1999-08, Vol.29 (2), p.361-366
Main Authors: Weinstein, Mitchell R., Dedier, Helen, Brunton, James, Campbell, Iivi, Conly, John M.
Format: Article
Language:English
Subjects:
Administration, Oral
Anti-Bacterial Agents - therapeutic use
Antibacterial agents
Antibiotics
Antibiotics. Antiinfectious agents. Antiparasitic agents
Antimicrobials
Bacitracin - therapeutic use
Biological and medical sciences
Clinical Articles
Control groups
Diseases
Doxycycline - therapeutic use
Drug Resistance, Microbial
Drug Therapy, Combination
Enterococcus faecium
Enterococcus faecium - drug effects
Enterococcus faecium - growth & development
Epidemiology
Feces - microbiology
Female
Follow-Up Studies
Gram-Positive Bacterial Infections - drug therapy
Gram-Positive Bacterial Infections - microbiology
Hospital units
Humans
Infections
Longitudinal Studies
Male
Medical sciences
Microbial colonization
Middle Aged
Patient surveillance
Pharmacology. Drug treatments
Prospective Studies
Vancomycin - pharmacology
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Summary:In a prospective observational cohort study designed to assess the role of oral bacitracin solution plus doxycycline in the eradication of intestinal carriage of vancomycin-resistant Enterococcus faecium (VREF) in patients on a renal ward, rectal swab specimens were obtained from 15 treated and 24 control patients. Cultures of the rectal swabs were negative for 15 (100%) of the antibiotic-treated vs. eight (33.3%) of the untreated patients (P < .001) on day 14. However, follow-up for a mean of 127 and 130 days revealed 9 of 15 (60%) and 15 of 24 (62.5%) in the treated and untreated cohorts (P = .86), respectively, carried VREF intermittently or persistently. Quantitative VREF stool cultures in the treated cohort revealed an initial 3.1-log10/g decrease, but there was an increase to pretreatment levels at 2–4 and 5–7 weeks post-treatment (7.8 and 7.4 log10/g). Oral bacitracin and doxycycline were not efficacious in reducing the carriage of VREF beyond the 2-week interval during which they were given.
ISSN:1058-4838
1537-6591
DOI:10.1086/520216