title: Decolonization of gastrointestinal carriage of vancomycin-resistant Enterococcus faecium: case series and review of literature.
abstract: BACKGROUND
  Prolonged asymptomatic carriage of vancomycin-resistant enterococci (VRE) in the gastrointestinal tract and the lack of effective decolonization regimen perpetuate the endemicity of VRE in the healthcare settings.
  
  
  METHODS
  We report a regimen for decolonization of gastrointestinal carriage of VRE by a combination of environmental disinfection, patient isolation, bowel preparation to wash-out the fecal bacterial population using polyethylene glycol, a five-day course of oral absorbable linezolid and non-absorbable daptomycin to suppress any remaining VRE, and subsequent oral Lactobacillus rhamnosus GG to maintain the colonization resistance in four patients, including two patients with end-stage liver cirrhosis, one patient with complication post liver transplant, and one patient with complicated infective endocarditis. All patients had clearance of VRE immediately after decolonization, and 3 of them remained VRE-free for 23 to 137 days of hospitalization, despite subsequent use of intravenous broad-spectrum antibiotics without anti-VRE activity.
  
  
  CONCLUSIONS
  This strategy should be further studied in settings of low VRE endemicity with limited isolation facilities.
authors.forename: Vincent C C
authors.initials: VC
authors.lastname: Cheng
authors.forename: Jonathan H K
authors.initials: JH
authors.lastname: Chen
authors.forename: Josepha W M
authors.initials: JW
authors.lastname: Tai
authors.forename: Sally C Y
authors.initials: SC
authors.lastname: Wong
authors.forename: Rosana W S
authors.initials: RW
authors.lastname: Poon
authors.forename: Ivan F N
authors.initials: IF
authors.lastname: Hung
authors.forename: Kelvin K W
authors.initials: KK
authors.lastname: To
authors.forename: Jasper F W
authors.initials: JF
authors.lastname: Chan
authors.forename: Pak-Leung
authors.initials: PL
authors.lastname: Ho
authors.forename: Chung-Mau
authors.initials: CM
authors.lastname: Lo
authors.affiliation: Department of Microbiology, Queen Mary Hospital, Hong Kong Special Administrative Region, Hong Kong, China. kyyuen@hkucc.hku.hk.
authors.forename: Kwok-Yung
authors.initials: KY
authors.lastname: Yuen
mesh_terms: D000368:Aged; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D002353:Carrier State / Q000382:microbiology; D003428:Cross Infection / Q000188:drug therapy / Q000382:microbiology / Q000517:prevention & control*; D016984:Enterococcus faecium / Q000187:drug effects / Q000254:growth & development*; D005260:Female; D041981:Gastrointestinal Tract / Q000382:microbiology*; D016908:Gram-Positive Bacterial Infections / Q000188:drug therapy / Q000382:microbiology / Q000517:prevention & control*; D006760:Hospitalization; D006801:Humans; D008297:Male; D008875:Middle Aged; D020713:Vancomycin Resistance
chemical_list: D000900:Anti-Bacterial Agents