Recurrence of vancomycin-resistant Enterococcus stool colonization during antibiotic therapy.
OBJECTIVE
To test the hypothesis that antibiotic therapy may promote recurrence of vancomycin-resistant Enterococcus (VRE) stool colonization in patients who have previously had three consecutive negative stool cultures obtained at least 1 week apart.


METHODS
One-year prospective cohort study examining the effect of antibiotic therapy on recurrence and density of VRE stool colonization in patients who have cleared colonization. Pulsed-field gel electrophoresis (PFGE) was performed to determine whether recurrent VRE strains were the same clone as the previous colonizing strain.


METHODS
A Department of Veterans Affairs medical center including an acute care hospital and nursing home.


METHODS
All patients with at least one stool culture positive for VRE who subsequently had three consecutive negative stool cultures obtained at least 1 week apart.


RESULTS
Of the 16 patients who cleared VRE colonization, 13 received antibiotic therapy during the study period. Eight (62%) of the 13 patients who received antibiotics developed recurrent high-density VRE stool colonization (range, 4.9 to 9.1 log10 colony-forming units per gram) during a course of therapy. Five patients had VRE strains available for PFGE analysis; recurrent strains were unrelated to the prior strain in 3 patients, closely related in 1 patient, and indistinguishable in 1 patient.


CONCLUSIONS
Antibiotic therapy may be associated with recurrent high-density VRE stool colonization in many patients who have previously had three consecutive negative stool cultures. These patients should be screened for recurrent stool colonization when antibiotic therapy is administered.
Infectious Diseases Section, Louis Stokes Cleveland Department of Veterans Affairs Medical Center, Ohio 44106, USA.
Curtis J
CJ
Donskey
Claudia K
CK
Hoyen
Sarbani M
SM
Das
Marion S
MS
Helfand
Michelle T
MT
Hecker
D000368:Aged; D000900:Anti-Bacterial Agents / Q000009:adverse effects*; D016022:Case-Control Studies; D003428:Cross Infection / Q000188:drug therapy* / Q000453:epidemiology; D016983:Enterococcus / Q000187:drug effects*; D016908:Gram-Positive Bacterial Infections / Q000188:drug therapy* / Q000453:epidemiology; D006801:Humans; D009820:Ohio / Q000453:epidemiology; D011446:Prospective Studies; D012008:Recurrence; D018709:Statistics, Nonparametric; D020713:Vancomycin Resistance
D000900:Anti-Bacterial Agents