title: Lack of efficacy of oral bacitracin plus doxycycline for the eradication of stool colonization with vancomycin-resistant Enterococcus faecium.
abstract: In a prospective observational cohort study designed to assess the role of oral bacitracin solution plus doxycycline in the eradication of intestinal carriage of vancomycin-resistant Enterococcus faecium (VREF) in patients on a renal ward, rectal swab specimens were obtained from 15 treated and 24 control patients. Cultures of the rectal swabs were negative for 15 (100%) of the antibiotic-treated vs. eight (33.3%) of the untreated patients (P < .001) on day 14. However, follow-up for a mean of 127 and 130 days revealed 9 of 15 (60%) and 15 of 24 (62.5%) in the treated and untreated cohorts (P = .86), respectively, carried VREF intermittently or persistently. Quantitative VREF stool cultures in the treated cohort revealed an initial 3.1-log10/g decrease, but there was an increase to pretreatment levels at 2-4 and 5-7 weeks post-treatment (7.8 and 7.4 log10/g). Oral bacitracin and doxycycline were not efficacious in reducing the carriage of VREF beyond the 2-week interval during which they were given.
authors.affiliation: Department of Medicine, The Toronto Hospital, University of Toronto, Ontario, Canada.
authors.forename: M R
authors.initials: MR
authors.lastname: Weinstein
authors.forename: H
authors.initials: H
authors.lastname: Dedier
authors.forename: J
authors.initials: J
authors.lastname: Brunton
authors.forename: I
authors.initials: I
authors.lastname: Campbell
authors.forename: J M
authors.initials: JM
authors.lastname: Conly
mesh_terms: D000284:Administration, Oral; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D001414:Bacitracin / Q000627:therapeutic use*; D004318:Doxycycline / Q000627:therapeutic use*; D004352:Drug Resistance, Microbial; D004359:Drug Therapy, Combination; D016984:Enterococcus faecium / Q000187:drug effects / Q000254:growth & development*; D005243:Feces / Q000382:microbiology; D005260:Female; D005500:Follow-Up Studies; D016908:Gram-Positive Bacterial Infections / Q000188:drug therapy* / Q000382:microbiology*; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D014640:Vancomycin / Q000494:pharmacology*
chemical_list: D000900:Anti-Bacterial Agents; D001414:Bacitracin; D014640:Vancomycin; D004318:Doxycycline