Vancomycin-Resistant Enterococci in Intensive Care Units

Ostrowsky, Belinda; Venkataraman, Lata; D’Agata, Erika M. C.; Gold, Howard S.; DeGirolami, Paola C.; Samore, Matthew H.

doi:10.1001/archinte.159.13.1467

Cited by 124 publications

(22 citation statements)

References 26 publications

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“…In summary, the model in its present form is a good approximation as long as the proportion of patients entering with resistant bacteria is modest compared with the endemic prevalence in the unit. In fact, the prevalence of colonization with resistant bacteria on admission ranges from a few percent to 15-18% in recent studies (35,36,(49)(50)(51)(52), which is considerably lower than the endemic prevalence in many cases. The model can be readily modified to quantitatively evaluate the consequences of having a greater fraction of the patients entering hospitals carrying resistant bacteria.…”

Section: Discussionmentioning

confidence: 95%

The epidemiology of antibiotic resistance in hospitals: Paradoxes and prescriptions

Lipsitch

Bergstrom

Levin

2000

Proc. Natl. Acad. Sci. U.S.A.

365

308

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Section: Discussionmentioning

confidence: 95%

The epidemiology of antibiotic resistance in hospitals: Paradoxes and prescriptions

Lipsitch

Bergstrom

Levin

2000

Proc. Natl. Acad. Sci. U.S.A.

365

308

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“…Parenteral vancomycin use and receipt of third-generation cephalosporins have been cited by others as risk factors for colonization or infection with VRE (61,180,181,247). 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).…”

Section: Risk Factorsmentioning

confidence: 97%

Vancomycin-Resistant Enterococci

Çetinkaya

Falk

Mayhall

2000

Clinical Microbiology Reviews

642

344

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“…Resistance to antibiotics has become an increasingly difficult problem in the management of infections with gram-positive bacteria (11). Methicillin-resistant S. aureus, coagulase-negative staphylococci, penicillin-resistant S. pneumoniae, and vancomycin-resistant enterococci all cause significant morbidity or mortality or both in U.S. hospitals (1,3,6,(7)(8)(9)(10)(11)13). Such isolates are frequently resistant to multiple classes of antibiotics, including tetracyclines, erythromycin, chloramphenicol, ␤-lactams, and trimethoprim-sulfamethoxazole (8).…”

mentioning

confidence: 99%

In Vitro Activities of the Glycylcycline GAR-936 against Gram-Positive Bacteria

Boucher

Wennersten

Eliopoulos

2000

Antimicrob Agents Chemother

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The in vitro activities of GAR-936, the 9-t-butylglycylamido derivative of minocycline, were compared with those of doxycycline, minocycline, and tetracycline against 527 gram-positive clinical isolates. GAR-936 inhibited all strains, including those resistant to other tetracyclines, at concentrations of <2 g/ml, except two strains of JK diphtheroids for which the MIC was 4 g/ml.Although tetracyclines remain valuable therapeutic agents for a variety of infections, resistance to this class limits their use against many important gram-positive bacterial pathogens. For example, only 33% of enterococci recovered at our hospital during 1997 to 1999 were susceptible to tetracycline. The glycylcyclines are novel tetracycline analogs that have activity against organisms resistant to older compounds of this class (5,14). They inhibit protein synthesis on wild-type ribosomes and on TetM-protected, tetracycline-resistant ribosomes (15). These compounds also inhibit organisms with tetracycline efflux determinants (14). GAR-936, the 9-t-butylglycylamido derivative of minocycline, appears to be both better tolerated by hosts and more active against tetracycline-resistant strains than earlier glycylcyclines (14). The present study examined the in vitro activities of GAR-936 against gram-positive bacteria, including strains resistant to ␤-lactams, glycopeptides, and other tetracyclines.Routine clinical isolates collected at the Beth Israel Deaconess Medical Center were included regardless of tetracycline resistance patterns. Staphylococci and most pneumococci were recovered in 1998. Strains with unusual resistance traits, including glycopeptide-resistant or ␤-lactamase-producing enterococci and ␤-lactam-resistant streptococci, had been referred to our laboratory from various sources over several years (2,4,16). Wyeth-Ayerst Laboratories, Pearl River, N.Y., kindly provided GAR-936. Tetracycline, minocycline, and doxycycline were purchased from Sigma Chemical Company, St. Louis, Mo.Activities of the antimicrobials were determined by agar dilution methods on Mueller-Hinton II agar (12). Media were supplemented with 5% sheep blood for testing streptococci and corynebacteria. Inocula of approximately 10 4 CFU were applied to the surfaces of plates and were incubated for 16 to 20 h at 35°C in air or in 5% CO 2 (for Lactobacillus spp., Leuconostoc spp., Streptococcus spp., Pediococcus spp., and diphtheroids). Pneumococci were also tested by broth microdilution (12).The results of susceptibility studies are shown in Table 1. GAR-936 was four times less active than minocycline against oxacillin-susceptible and -resistant strains of Staphylococcus aureus, according to a comparison of MICs at which 90% of the isolates tested were inhibited (MIC 90 s). However, isolates intermediately susceptible or resistant to the other compounds were inhibited by GAR-936 at Յ1 g/ml. GAR-936 inhibited two strains of vancomycin-intermediate S. aureus (resistant to tetracycline and minocycline) at concentrations of 1 and 2 g/ml.Against coagulase-negative s...

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Vancomycin-Resistant Enterococci in Intensive Care Units

Cited by 124 publications

References 26 publications

The epidemiology of antibiotic resistance in hospitals: Paradoxes and prescriptions

The epidemiology of antibiotic resistance in hospitals: Paradoxes and prescriptions

Vancomycin-Resistant Enterococci

In Vitro Activities of the Glycylcycline GAR-936 against Gram-Positive Bacteria

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