Observations on the risk of resistance with the extended use of vancomycin.

OBJECTIVE To document the risk of the development of vancomycin-resistant bacteria in a population of seriously burned patients during a 10-year period of common vancomycin hydrochloride use. DESIGN Retrospective study. SETTING The US Army Institute of Surgical Research, Burn Center, Fort Sam Houston, Tex. POPULATION AND METHODS Microbiology, infection, and antibiotic use records collected during the hospitalization of 2266 consecutively admitted seriously burned patients were reviewed. Vancomycin was the primary therapeutic agent used for gram-positive infections and was also used as a perioperative prophylactic antibiotic during burn wound excision. This policy was established prior to this review because of a high incidence of methicillin-resistant Staphylococcus aureus colonization and an anecdotal association of increased beta-lactam resistance in endemic gram-negative pathogens associated with the use of penicillinase-resistant penicillins and cephalosporins. MAIN OUTCOME MEASURES Isolation of vancomycin-resistant enterococci (VRE) or other gram-positive organisms resistant to vancomycin. RESULTS Examinations of 15 125 gram-positive isolates, including 957 enterococci, for in vitro sensitivity to vancomycin yielded 3 VRE isolates in 3 patients. Vancomycin was used prior to VRE isolation in one of these patients. Resistance was found in 3 other organisms (2 Corynebacterium species, 1 Lactobacillus species). Vancomycin was used prior to these isolations in 2 of 3 patients. None of the vancomycin-resistant organisms was associated with infection and all 6 patients survived. Vancomycin-resistant enterococci or other vancomycin-resistant gram-positive organisms were not found in 663 patients treated with vancomycin for documented gram-positive infections or in 1027 patients where perioperative vancomycin was used. CONCLUSION Use of vancomycin as the primary therapeutic agent in seriously burned patients was not associated with increased risk of VRE isolation or VRE infection.

[1]  B. Murray,et al.  Diversity among multidrug-resistant enterococci. , 1998, Emerging infectious diseases.

[2]  B. Pruitt,et al.  Incidence of bacteremia after burn wound manipulation in the early postburn period. , 1997, The Journal of trauma.

[3]  P. Barie,et al.  Surgical Infection Society position on vancomycin-resistant Enterococcus. , 1997, Archives of surgery.

[4]  P. Barie,et al.  Surgical infection society position on vancomycin-resistant Enterococcus , 1996 .

[5]  M. Gilchrist,et al.  Recommendations for Preventing the Spread of Vancomycin Resistance , 1995, Infection Control & Hospital Epidemiology.

[6]  A. Mason,et al.  A decade of reduced gram-negative infections and mortality associated with improved isolation of burned patients. , 1994, Archives of surgery.

[7]  B. Cookson,et al.  Vancomycin-resistant enterococci , 1993, The Lancet.

[8]  Nosocomial enterococci resistant to vancomycin--United States, 1989-1993. , 1993, MMWR. Morbidity and mortality weekly report.

[9]  R. Moellering.  Emergence of Enterococcus as a significant pathogen. , 1992, Clinical infectious diseases : an official publication of the Infectious Diseases Society of America.

[10]  W. Noble,et al.  Co-transfer of vancomycin and other resistance genes from Enterococcus faecalis NCTC 12201 to Staphylococcus aureus. , 1992, FEMS microbiology letters.

[11]  D. Shlaes.  Vancomycin-resistant bacteria. , 1992, Infection control and hospital epidemiology.

[12]  R. Gaynes,et al.  Major trends in the microbial etiology of nosocomial infection. , 1991, The American journal of medicine.

[13]  S Chattopadhyay,et al.  Production of L-dopa by Aspergillus terreus. , 1990, FEMS microbiology letters.

[14]  A. Mason,et al.  What's in a name? Is methicillin-resistant Staphylococcus aureus just another S aureus when treated with vancomycin? , 1989, Archives of surgery.

[15]  J. Duval,et al.  Transferable vancomycin and teicoplanin resistance in Enterococcus faecium , 1989, Antimicrobial Agents and Chemotherapy.

[16]  A. Mason,et al.  Effects of environment on infection in burn patients. , 1986, Archives of surgery.

[17]  E. Bruck,et al.  National Committee for Clinical Laboratory Standards. , 1980, Pediatrics.