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Linden, Peter K.; Pasculle, A. William; Manez, Rafael; Fung, John J.; Pinna, A.D.; Kusne, Shimon

doi:10.1093/clinids/24.3.530-a

Cited by 7 publications

(5 citation statements)

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“…Data from the Centers for Disease Control and Prevention (7) or collected through a national surveillance program (23) point to a preponderance of the VanA phenotype among vancomycin-resistant strains of E. faecium and to high rates of resistance to other agents. Therapeutic regimens against infections caused by such multidrugresistant strains have employed agents such as doxcycline or chloramphenicol (20,26,29) or unusual combinations like novobiocin-ciprofloxacin (24). Nevertheless, the mortality of patients infected with multiply antibiotic-resistant E. faecium remains high (11,25,33).…”

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confidence: 99%

Characterization of Vancomycin-Resistant Enterococcus faecium Isolates from the United States and Their Susceptibility In Vitro to Dalfopristin-Quinupristin

Eliopoulos

Wennersten

Gold

et al. 1998

Antimicrob Agents Chemother

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In the course of clinical studies with the investigational streptogramin antimicrobial dalfopristin-quinupristin, isolates of vancomycin-resistant Enterococcus faecium were referred to our laboratory from across the United States. Seventy-two percent of the strains were of the VanA type, phenotypically and genotypically, while 28% were of the VanB type. High-level resistance to streptomycin or gentamicin was observed in 86 and 81%, respectively, of the VanA strains but in only 69 and 66%, respectively, of the VanB strains. These enterococci were resistant to ampicillin (MIC for 50% of the isolates tested [MIC50] and MIC90, 128 and 256 μg/ml, respectively) and to the other approved agents tested, with the exception of chloramphenicol (MIC90, 8 μg/ml) and novobiocin (MIC90, 1 μg/ml). Considering all of the isolates submitted, dalfopristin-quinupristin inhibited 86.4% of them at concentrations of ≤1 μg/ml and 95.1% of them at ≤2 μg/ml. However, for the data set comprised of only the first isolate submitted for each patient, 94.3% of the strains were inhibited at concentrations of ≤1 μg/ml and 98.9% were inhibited at concentrations of ≤2 μg/ml. Multiple drug resistance was very common among these isolates of vancomycin-resistant E. faecium, while dalfopristin-quinupristin inhibited the majority at concentrations that are likely to be clinically relevant.

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mentioning

confidence: 99%

Characterization of Vancomycin-Resistant Enterococcus faecium Isolates from the United States and Their Susceptibility In Vitro to Dalfopristin-Quinupristin

Eliopoulos

Wennersten

Gold

et al. 1998

Antimicrob Agents Chemother

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“…Vancomycin-resistant E. faecium has been reported in oncology and LTx patients [5,9,18,231. No such development of resistance was detected in the present study.…”

Section: Discussionmentioning

confidence: 99%

Stool cultures obtained before liver transplantation are useful for choice of perioperative antibiotic prophylaxis

Barkholt

Andersson

Ericzon

et al. 1997

Transplant International

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Stool cultures obtained before liver transplantation are useful for choice of perioperative anti biotic prophylaxisAbstract Bacterial infections, especially cholangitis, are still common complications after liver transplantation (LTx). During recent years, multiresistant enterococci have become a nosocomial problem in transplant units. The present prospective study on 26 patients, including 24 patients with chronic liver disease, demonstrated that enterococci were the predominant micro-organism involved in post-LTx bacterial infections. They were cultured in the feces and in other sites of 10 out of 13 (77 %) patients who underwent extensive examinations. Ampicillin-resistant Enterococcus faecium strains were isolated in urine or feces of 2 of the 13 patients prior to LTx. Similarly, resistance to ampicillin and gentamicin, the empirically used antibiotics for patients with fever of unknown origin, was found in E. faecium strains in 3 and 2 patients, respectively. Moreover, multiresistant E. faecium and E. faecalis strains were demonstrated in 46 % of the patients in the postoperative period (3 months). However, no vancomycin-resistant enterococci were isolated. The use of antibiotics within 4 months prior to LTx significantly increased the risk of developing ampicillin-resistant bacteria at the time of LTx and of infections with bacteria of enteric origin after LTx ( P = 0.03 and 0.01, respectively). We conclude that stool and urine cultures performed prior to LTX may be useful for selecting prophylactic antibiotic regimens.

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“…Multi-resistant bacteria have been increasingly reported in transplant centers [16,17]. Fecal carriage of Vancomycinresistant Enterococcus faecium was observed in 23% of liver recipients in one institution, and hospital and intensive care stay were significantly longer in these patients compared with patients who had the vancomycin-sensitive strain [18]. Almost all Staphylococcus, two thirds of gram-negative bacilli, and one half of enterococcus infections have been multi-resistant among liver transplant patients.…”

Section: Liver Recipients Incidence and Risk Factorsmentioning

confidence: 98%

“…If the MRSA bacteremia is associated with pneumonia, the mortality is 86%, but if it is catheter-related, the mortality falls to 6% [19]. The presence of vancomycin-resistant E. faecium is associated with a crude mortality of 46%, compared to 25% in patients with vancomycinsusceptible E. faecium [18].…”

Section: General Management and Prognosismentioning

confidence: 99%

Sepsis and Solid Organ Transplantation

Kalil¹,

Dakroub²,

Freifeld³

2007

CDT

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Approximately seventy patients undergo solid organ transplantation (SOT) every day in the United States. Sepsis remains the first or second most common cause of death in transplant recipients, depending on the allograft type. The rapid diagnosis and treatment of sepsis is critical to ensure improved survival outcome in this special patient population. However, these patients frequently lack the classic systemic inflammatory response syndrome (SIRS), commonly seen in the immunocompetent patients. In order to minimize delays in the diagnosis of sepsis in SOT recipients, it is paramount to recognize the specific risk factors for infection associated with each allograft type. In addition, the particular surgical techniques involved in each type of transplantation may be closely related to the clinical manifestations of the infection process. This correlation can further advance the diagnosis and treatment of sepsis. In conclusion, precocious diagnosis, rapid initiation of antibiotics, surgical correction when necessary, and reduction of immunosuppression, are the mainstream approach to sepsis in the SOT patient. The recent developments in severe sepsis are discussed in the context of the transplant recipient.

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Cited by 7 publications

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Characterization of Vancomycin-Resistant Enterococcus faecium Isolates from the United States and Their Susceptibility In Vitro to Dalfopristin-Quinupristin

Characterization of Vancomycin-Resistant Enterococcus faecium Isolates from the United States and Their Susceptibility In Vitro to Dalfopristin-Quinupristin

Stool cultures obtained before liver transplantation are useful for choice of perioperative antibiotic prophylaxis

Sepsis and Solid Organ Transplantation

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