Third-generation cephalosporins and vancomycin as risk factors for postoperative vancomycin-resistant enterococcus infection.
OBJECTIVE
To examine use of third-generation cephalosporins (3GCs) alone and in association with vancomycin hydrochloride as a risk factor for vancomycin-resistant enterococcus (VRE) infection in surgical patients.


METHODS
Case-control retrospective study analyzing antibiotic use in the 30 days preceding culture of VRE or vancomycin-sensitive enterococcus from an infected site.


METHODS
A large tertiary care teaching hospital.


METHODS
Surgical inpatients with VRE infections between September 3, 1993, and January 29, 1997, were matched with patients with vancomycin-sensitive enterococcus infections. Matches were based on surgical procedure, initial infection site, and immunosuppression. Matches were found for 32 of 50 surgical patients with VRE. Twenty matched pairs of patients were recipients of solid organ transplants.


METHODS
Multivariate logistic regression analysis was done to examine 3GCs and vancomycin as risk factors for VRE infection. Univariate analysis of use of other antibiotic agents and demographic data was also performed.


RESULTS
Multivariate analysis showed significant differences in the use of 3GCs both alone and concurrently with vancomycin. Univariate analysis also showed higher use of metronidazole, concurrent vancomycin and metronidazole, concurrent vancomycin and ceftazidime, and all antibiotics combined in patients with VRE infections.


CONCLUSIONS
This matched control study showed that use of 3GCs, alone (P=.05) or concurrently with vancomycin (P=.05), was a risk factor for VRE infection in surgical patients. Judicious administration of third-generation antibiotics is warranted in surgical patients with other risk factors for VRE.
Dahms
R A
RA
Department of Surgery, University of Minnesota Medical School, Minneapolis 55455, USA.
Johnson
E M
EM
Statz
C L
CL
Lee
J T
JT
Dunn
D L
DL
Beilman
G J
GJ
D000328:Adult; D000900:Anti-Bacterial Agents / Q000494:pharmacology* / Q000627:therapeutic use*; D002511:Cephalosporins / Q000627:therapeutic use*; D004352:Drug Resistance, Microbial; D016983:Enterococcus / Q000187:drug effects*; D016908:Gram-Positive Bacterial Infections / Q000188:drug therapy*; D006801:Humans; D015999:Multivariate Analysis; D011183:Postoperative Complications / Q000188:drug therapy*; D012189:Retrospective Studies; D012307:Risk Factors; D014640:Vancomycin / Q000494:pharmacology* / Q000627:therapeutic use*
D000900:Anti-Bacterial Agents; D002511:Cephalosporins; D014640:Vancomycin