Vancomycin-Resistant Enterococci in Stool Specimens Submitted for Clostridium difficile Cytotoxin Assay

Rafferty, Mary Ellen; McCormick, Maggie; Bopp, Lawrence H.; Baltch, Aldona L.; George, Mary; Smith, Raymond P.; Rheal, Carol; Ritz, William J.; Schoonmaker, D.

doi:10.2307/30141229

Cited by 22 publications

(13 citation statements)

References 7 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…A notable pattern in our study is that the regions with the higher incidence of CDAD (Northeast and Midwest) also exhibited higher incidence of VRE in at least half of the study period, consistent with the observation that infection with CDAD can facilitate transmission of VRE (10,11). The South had the highest incidence of MRSA and lowest incidence of VRE.…”

Section: Discussionsupporting

confidence: 73%

Growth and Geographic Variation in Hospitalizations with Resistant Infections, United States, 2000–2005

Zilberberg¹,

Shorr²,

Kollef³

2008

Emerg. Infect. Dis.

View full text Add to dashboard Cite

Section: Discussionsupporting

confidence: 73%

Growth and Geographic Variation in Hospitalizations with Resistant Infections, United States, 2000–2005

Zilberberg¹,

Shorr²,

Kollef³

2008

Emerg. Infect. Dis.

View full text Add to dashboard Cite

“…the incidence rate of cDAD during this study period was 0.2%. Univariate analysis showed that the case patients were more likely than the control patients to have chronic lung diseases (29 blocker showed a protective effect to cDAD (or, 0.30; 95% ci, 0.13-0.69; p = 0.005). Among surgeries, orthopedic surgery had the greatest risk, followed by neurosurgery and gastrointestinal surgery.…”

Section: Resultsmentioning

confidence: 97%

Clinical risk factors for Clostridium difficile-associated diseases

Cho¹,

Lee²,

Yoon³

2012

Braz J Infect Dis

View full text Add to dashboard Cite

A b s t r A c t Many factors appear to influence the chance of acquiring Clostridium difficile (c. difficile)infection, and an accurate identification of risk factors could be beneficial in many ways.thus, in the present study, clinical risk factors for c. difficile-associated disease (cDAD) in Korea were identified. A total of 93 patients who met the inclusion criteria and 186 age/gender/ward/admission period-matched control patients were included in this study. (or, 14.90; 95% ci, 4.02-55.26; p < 0.001). Awareness of cDAD is critical to provide appropriate clinical care. surveillance of the national incidence rate and multicenter studies are needed, and the potential value of a c. difficile vaccine should be studied.

show abstract

“…This should be another reason to relegate vancomycin to a second position as the drug of choice for the treatment of CDAD. The risk of development of colonization with VRE and VRE superinfections in patients treated with oral vancomycin is already known (39,40,42).…”

Section: Discussionmentioning

confidence: 99%

Reassessment of Clostridium difficile Susceptibility to Metronidazole and Vancomycin

Peláez

Alcalá

Alonso

et al. 2002

Antimicrob Agents Chemother

224

119

View full text Add to dashboard Cite

Clostridium difficile is the most frequently identified enteric pathogen in patients with nosocomially acquired, antibiotic-associated diarrhea. The drugs most commonly used to treat diseases associated with C. difficile are metronidazole and vancomycin. Most clinical laboratories assume that all C. difficile isolates are susceptible to metronidazole and vancomycin. We report on the antimicrobial susceptibilities of 415 C. difficile isolates to metronidazole and vancomycin over an 8-year period (1993 to 2000). The overall rate of resistance to metronidazole at the critical breakpoint (16 g/ml) was 6.3%. Although full resistance to vancomycin was not observed, the overall rate of intermediate resistance was 3.1%. One isolate had a combination of resistance to metronidazole and intermediate resistance to vancomycin. Rates of resistance to metronidazole and vancomycin were higher among isolates from human immunodeficiency virus-infected patients. Molecular typing methods proved the absence of clonality among the isolates with decreased susceptibilities to the antimicrobials tested.Clostridium difficile-associated diarrhea (CDAD) is the most common nosocomial diarrhea in adults, occurring mainly in patients with prior antimicrobial therapy. The disease has variable incidences and severities in different hospital populations (2,6,22,25,27,38) The most serious cases of CDAD require antimicrobial therapy with agents which are active against C. difficile. Metronidazole is the drug of choice due to its in vitro activity, its efficacy by either the oral or the intravenous route of administration, its presumed lower potential for selection of vancomycin-resistant Enterococcus (VRE), and the low cost of treatment with the drug. Nowadays, vancomycin is considered a second-line drug, mainly due to the potential for the selection of VRE and its high cost. Both drugs are considered equivalent in efficacy, but infection recurrence rates of 15 to 35% have been reported for both drugs (3, 7).In vitro determination of the susceptibility of C. difficile to these antibiotics is not routinely performed, as it is broadly accepted that C. difficile is regularly and predictably susceptible to metronidazole and vancomycin. The assay method is timeconsuming, and the use of susceptibility breakpoints is based on the therapeutic levels of drugs in serum and not on the levels in the intraluminal area, where higher drug concentrations can be achieved (1,19). At present, metronidazole resistance in C. difficile is considered anecdotal and vancomycin resistance has been, to the best of our knowledge, reported only once (16), although on that occasion the method used was not the present standard.In 1994, we sounded the alarm when we reported on the first series of metronidazole-resistant C. difficile isolates (T. Peláez, R. Sánchez, R. Blázquez, P. Catalán, P. Muñoz, and E. Bouza, Abstr. 34th. Intersci. Conf. Antimicrob. Agents Chemother., abstr. E-34, p. 50, 1994). The aim of the present study is to report on the decrease in the rates of suscept...

show abstract

Vancomycin-Resistant Enterococci in Stool Specimens Submitted for Clostridium difficile Cytotoxin Assay

Cited by 22 publications

References 7 publications

Growth and Geographic Variation in Hospitalizations with Resistant Infections, United States, 2000–2005

Growth and Geographic Variation in Hospitalizations with Resistant Infections, United States, 2000–2005

Clinical risk factors for Clostridium difficile-associated diseases

Reassessment of Clostridium difficile Susceptibility to Metronidazole and Vancomycin

Contact Info

Product

Resources

About