Molecular characterization of vancomycin-resistant Enterococci repopulating the gastrointestinal tract following treatment with a novel glycolipodepsipeptide, ramoplanin.
We characterized baseline and repopulating stool isolates recovered during a phase II trial of ramoplanin for the treatment of patients with stool carriage of vancomycin-resistant enterococci (VRE). Repopulation with a strain with a related genotype was found in 74, 60, and 53% of individuals in groups treated with placebo, 100 mg of ramoplanin, and 400 mg of ramoplanin, respectively. All ramoplanin-treated patients with a culture positive for VRE at day 7 had a relapse caused by a genotypically related isolate. In ramoplanin-treated patients, antibiotics with activities against anaerobic organisms were associated with positive cultures on day 7 (relative risk [RR] = 8.8; P = 0.004), and the avoidance of such antibiotics was significantly associated with culture negativity through day 21 (RR = 0.16; P = 0.02).
Baden
L R
LR
Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts, USA. lbaden@partners.org
Critchley
I A
IA
Sahm
D F
DF
So
W
W
Gedde
M
M
Porter
S
S
Moellering
R C
RC
Eliopoulos
G
G
D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D002353:Carrier State / Q000188:drug therapy* / Q000382:microbiology; D047630:Depsipeptides; D004064:Digestive System / Q000382:microbiology*; D016983:Enterococcus / Q000145:classification / Q000187:drug effects / Q000235:genetics*; D005243:Feces / Q000382:microbiology; D005838:Genotype; D016908:Gram-Positive Bacterial Infections / Q000188:drug therapy* / Q000382:microbiology; D006801:Humans; D010456:Peptides, Cyclic; D016133:Polymerase Chain Reaction; D020713:Vancomycin Resistance
D000900:Anti-Bacterial Agents; D047630:Depsipeptides; D010456:Peptides, Cyclic; C041438:ramoplanin