Antecedent treatment with different antibiotic agents as a risk factor for vancomycin-resistant Enterococcus.
We conducted a matched case-control study to compare the effect of antecedent treatment with various antibiotics on subsequent isolation of vancomycin-resistant Enterococcus (VRE); 880 in-patients; 233 VRE cases, and 647 matched controls were included. After being matched for hospital location, calendar time, and duration of hospitalization, the following variables predicted VRE positivity: main admitting diagnosis; a coexisting condition (e.g., diabetes mellitus, organ transplant, or hepatobiliary disease); and infection or colonization with methicillin-resistant Staphylococcus aureus or Clostridium difficile within the past year (independent of vancomycin treatment). After controlling for these variables, we examined the effect of various antibiotics. Intravenous treatment with third-generation cephalosporins, metronidazole, and fluoroquinolones was positively associated with VRE. In our institution, when we adjusted the data for temporo-spatial factors, patient characteristics, and hospital events, treatment with third-generation cephalosporins, metronidazole, and fluoroquinolones was identified as a risk factor for VRE. Vancomycin was not a risk factor for isolation of VRE.
Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA. ycarmeli@caregroup.harvard.edu
Yehuda
Y
Carmeli
George M
GM
Eliopoulos
Matthew H
MH
Samore
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000008:administration & dosage / Q000494:pharmacology*; D000890:Anti-Infective Agents / Q000008:administration & dosage / Q000494:pharmacology; D016022:Case-Control Studies; D002511:Cephalosporins / Q000008:administration & dosage / Q000494:pharmacology; D016983:Enterococcus / Q000187:drug effects*; D024841:Fluoroquinolones; D016908:Gram-Positive Bacterial Infections / Q000188:drug therapy; D006801:Humans; D008795:Metronidazole / Q000008:administration & dosage / Q000494:pharmacology; D008875:Middle Aged; D012307:Risk Factors; D014640:Vancomycin / Q000008:administration & dosage / Q000494:pharmacology*; D020713:Vancomycin Resistance
D000900:Anti-Bacterial Agents; D000890:Anti-Infective Agents; D002511:Cephalosporins; D024841:Fluoroquinolones; D008795:Metronidazole; D014640:Vancomycin