title: Alternate antimicrobial therapy for vancomycin-resistant enterococci burn wound infections.
abstract: Survival after a major thermal burn is precarious and fraught with difficult complications associated with hypermetabolism, gut or respiratory dysfunction, and infection. Clinicians must be cognizant of a new threat to the patient with burn injuries--the emergence of vancomycin-resistant enterococci (VRE). In an analysis of 31 clinical isolates obtained during acute burn hospitalization, an optimal antimicrobial therapy for VRE has been identified. All VRE cultures were inoculated to the MicroScan Gram-Positive Breakpoint Combo Panel #8 (Dade Microscan, Inc, Sacramento, Calif), which speciates the enterococci, provides antimicrobial susceptibility patterns (including vancomycin) and a biotype, and examines streptomycin and gentamicin synergy. Eleven (35.5%) of the 31 isolates were identified as E faecium and 20 (64.5%) as E faecalis. All isolates were susceptible to chloramphenicol and tetracycline, whereas only half were sensitive to gentamicin synergy screen. All other antimicrobials screened against VRE were either ineffective or of limited effect. Our preliminary data supports the initiation of chloramphenicol therapy when a VRE burn wound infection is encountered or suspected.
authors.affiliation: Shriners Burns Institute, Galveston, TX 77550, USA.
authors.forename: J P
authors.initials: JP
authors.lastname: Heggers
authors.forename: L
authors.initials: L
authors.lastname: McCoy
authors.forename: B
authors.initials: B
authors.lastname: Reisner
authors.forename: M
authors.initials: M
authors.lastname: Smith
authors.forename: P
authors.initials: P
authors.lastname: Edgar
authors.forename: R J
authors.initials: RJ
authors.lastname: Ramirez
mesh_terms: D000900:Anti-Bacterial Agents / Q000494:pharmacology* / Q000627:therapeutic use*; D002056:Burns / Q000150:complications* / Q000382:microbiology; D002701:Chloramphenicol / Q000494:pharmacology / Q000627:therapeutic use*; D004352:Drug Resistance, Microbial; D013293:Enterococcus faecalis / Q000187:drug effects*; D016984:Enterococcus faecium / Q000187:drug effects*; D016908:Gram-Positive Bacterial Infections / Q000188:drug therapy*; D006801:Humans; D008826:Microbial Sensitivity Tests; D014640:Vancomycin / Q000494:pharmacology*; D014946:Wound Infection / Q000188:drug therapy / Q000382:microbiology*
chemical_list: D000900:Anti-Bacterial Agents; D002701:Chloramphenicol; D014640:Vancomycin