Observations on the risk of resistance with the extended use of vancomycin.
OBJECTIVE
To document the risk of the development of vancomycin-resistant bacteria in a population of seriously burned patients during a 10-year period of common vancomycin hydrochloride use.


METHODS
Retrospective study.


METHODS
The US Army Institute of Surgical Research, Burn Center, Fort Sam Houston, Tex.


METHODS
Microbiology, infection, and antibiotic use records collected during the hospitalization of 2266 consecutively admitted seriously burned patients were reviewed. Vancomycin was the primary therapeutic agent used for gram-positive infections and was also used as a perioperative prophylactic antibiotic during burn wound excision. This policy was established prior to this review because of a high incidence of methicillin-resistant Staphylococcus aureus colonization and an anecdotal association of increased beta-lactam resistance in endemic gram-negative pathogens associated with the use of penicillinase-resistant penicillins and cephalosporins.


METHODS
Isolation of vancomycin-resistant enterococci (VRE) or other gram-positive organisms resistant to vancomycin.


RESULTS
Examinations of 15 125 gram-positive isolates, including 957 enterococci, for in vitro sensitivity to vancomycin yielded 3 VRE isolates in 3 patients. Vancomycin was used prior to VRE isolation in one of these patients. Resistance was found in 3 other organisms (2 Corynebacterium species, 1 Lactobacillus species). Vancomycin was used prior to these isolations in 2 of 3 patients. None of the vancomycin-resistant organisms was associated with infection and all 6 patients survived. Vancomycin-resistant enterococci or other vancomycin-resistant gram-positive organisms were not found in 663 patients treated with vancomycin for documented gram-positive infections or in 1027 patients where perioperative vancomycin was used.


CONCLUSIONS
Use of vancomycin as the primary therapeutic agent in seriously burned patients was not associated with increased risk of VRE isolation or VRE infection.
McManus
A T
AT
US Army Institute of Surgical Research, Fort Sam Houston, Tex 78234-6315, USA.
Goodwin
C W
CW
Pruitt
B A
BA
D000328:Adult; D000900:Anti-Bacterial Agents / Q000009:adverse effects*; D019072:Antibiotic Prophylaxis; D002056:Burns / Q000150:complications*; D003428:Cross Infection / Q000209:etiology / Q000517:prevention & control*; D004352:Drug Resistance, Microbial; D016908:Gram-Positive Bacterial Infections / Q000209:etiology / Q000517:prevention & control*; D006801:Humans; D017053:Infection Control; D008826:Microbial Sensitivity Tests; D012189:Retrospective Studies; D012307:Risk Factors; D014640:Vancomycin / Q000009:adverse effects*; D014946:Wound Infection / Q000209:etiology / Q000517:prevention & control*
D000900:Anti-Bacterial Agents; D014640:Vancomycin