Does oral doxycycline treatment affect eradication of urine vancomycin-resistant Enterococcus? A tertiary hospital study
2
조회
0
다운로드
0
인용
0
참고문헌
키워드
초록
Background: Vancomycin-resistant Enterococcus (VRE) has become more common in nosocomial infections, especially in urine samples. However, until now, no treatment regimen has been proven to effectively eradicate urine VRE colonization. Therefore, to evaluate the efficacy of doxycycline in eradicating urine VRE and shortening VRE isolation period, we compared VRE colony detection period between doxycycline-treated and untreated patients. Methods: A retrospective cohort study of 83 patients with VRE colonization in urine cultures was conducted at a tertiary academic hospital from January 2011 to February 2018. Kaplan-Meier survival analysis was used to evaluate eradication rates in the treatment and non-treatment groups. Factors affecting urine VRE colonization persistence were analyzed by multiple logistic regression analysis. Results: The overall rate of VRE eradication during the entire hospital stay was higher in the doxycycline treatment group (90.5%) than in the non-treatment group (58.1%, p=0.014). Survival analysis showed that the 5-, 10-, and 20-day cumulative eradication rates were 78.3%, 100%, and 100% in the doxycycline treatment group, and 18.5%, 45.7%, and 67.8% in the non-treatment group, respectively, thereby indicating that eradication rates were higher in the doxycycline treatment group than in the non-treatment group (p
Abstract
Background: Vancomycin-resistant Enterococcus (VRE) has become more common in nosocomial infections, especially in urine samples. However, until now, no treatment regimen has been proven to effectively eradicate urine VRE colonization. Therefore, to evaluate the efficacy of doxycycline in eradicating urine VRE and shortening VRE isolation period, we compared VRE colony detection period between doxycycline-treated and untreated patients. Methods: A retrospective cohort study of 83 patients with VRE colonization in urine cultures was conducted at a tertiary academic hospital from January 2011 to February 2018. Kaplan-Meier survival analysis was used to evaluate eradication rates in the treatment and non-treatment groups. Factors affecting urine VRE colonization persistence were analyzed by multiple logistic regression analysis. Results: The overall rate of VRE eradication during the entire hospital stay was higher in the doxycycline treatment group (90.5%) than in the non-treatment group (58.1%, p=0.014). Survival analysis showed that the 5-, 10-, and 20-day cumulative eradication rates were 78.3%, 100%, and 100% in the doxycycline treatment group, and 18.5%, 45.7%, and 67.8% in the non-treatment group, respectively, thereby indicating that eradication rates were higher in the doxycycline treatment group than in the non-treatment group (p
참고문헌 (26)
- Faron ML, "Resistance mechanisms, epidemiology, and approaches to screening for vancomycin-resistant enterococcus in the health care setting", J Clin Microbiol, 54, pp.2436~2447 (2016)
- Puchter L, "Economic burden of nosocomial infections caused by vancomycin-resistant enterococci", Antimicrob Resist Infect Control, 7, pp.1~ (2018)
- Kauffman CA, "Therapeutic and preventative options for the management of vancomycin-resistant enterococcal infections", J Antimicrob Chemother, 51(Suppl 3), pp.iii23~iii30 (2003)
- Lloyd-Smith P, "Economic analysis of vancomycin-resistant enterococci at a Canadian hospital : assessing attributable cost and length of stay", J Hosp Infect, 85, pp.54~59 (2013)
- Shenoy ES, "Natural history of colonization with methicillin-resistant Staphylococcus aureus(MRSA)and vancomycin-resistant Enterococcus(VRE) : a systematic review", BMC Infect Dis, 14, pp.177~ (2014)
- Pereira GH, "Outbreak of vancomycin-resistant enterococci in a tertiary hospital : the lack of effect of measures directed mainly by surveillance cultures and differences in response between Enterococcus faecium and Enterococcus faecalis", Am J Infect Control, 38, pp.406~409 (2010)
- Weinstein MR, "Lack of efficacy of oral bacitracin plus doxycycline for the eradication of stool colonization with vancomycin-resistant Enterococcus faecium", Clin Infect Dis, 29, pp.361~366 (1999)
- Trautner BW, "Effectiveness of an antimicrobial stewardship approach for urinary catheter-associated asymptomatic bacteriuria", JAMA Intern Med, 175, pp.1120~1127 (2015)
- Chopra I, "Tetracycline antibiotics: mode of action, applications, molecular biology, and epidemiology of bacterial resistance", Microbiol Mol Biol Rev, 65, pp.232~260 (2001)
- Agwuh KN, "Pharmacokinetics and pharmacodynamics of the tetracyclines including glycylcyclines", J Antimicrob Chemother, 58, pp.256~265 (2006)
- Holmes NE, "Safety and efficacy review of doxycycline", Clin Med Ther, 1, pp.471~482 (2009)
- Gupta K, "Management of urinary tract infections from multidrug-resistant organisms", Infect Dis Clin North Am, 28, pp.49~59 (2014)
- Wong AH, "Epidemiology of bacteriuria caused by vancomycin-resistant enterococci : a retrospective study", Am J Infect Control, 28, pp.277~281 (2000)
- Drees M, "Prior environmental contamination increases the risk of acquisition of vancomycin-resistant enterococci", Clin Infect Dis, 46, pp.678~685 (2008)
- Olivier CN, "Risk of vancomycin-resistant Enterococcus(VRE)bloodstream infection among patients colonized with VRE", Infect Control Hosp Epidemiol, 29, pp.404~409 (2008)
- Edmond MB, "Vancomycin-resistant enterococcal bacteremia : natural history and attributable mortality", Clin Infect Dis, 23, pp.1234~1239 (1996)
- Edmond MB, "Vancomycin-resistant Enterococcus faecium bacteremia : risk factors for infection", Clin Infect Dis, 20, pp.1126~1133 (1995)
- Tornieporth NG, "Risk factors associated with vancomycin-resistant Enterococcus faecium infection or colonization in 145 matched case patients and control patients", Clin Infect Dis, 23, pp.767~772 (1996)
- Montecalvo MA, "Bloodstream infections with vancomycin-resistant enterococci", Arch Intern Med, 156, pp.1458~1462 (1996)
- Weinstock DM, "Colonization, bloodstream infection, and mortality caused by vancomycin-resistant enterococcus early after allogeneic hematopoietic stem cell transplant", Biol Blood Marrow Transplant, 13, pp.615~621 (2007)
- 최희경, "Risk Factors for Recurrence of Clostridium difficile Infection: Effect of Vancomycin-resistant Enterococci Colonization", Journal of Korean Medical Science, 26(7), pp.859~864 (2011), 대한의학회
- Dancer SJ, "The problem with cephalosporins", J Antimicrob Chemother, 48, pp.463~478 (2001)
- Shepard BD, "Antibiotic-resistant enterococci : the mechanisms and dynamics of drug introduction and resistance", Microbes Infect, 4, pp.215~224 (2002)
- Antibiotic resistance threats in the United States, "Centers for Disease Control and Prevention", Centers for Disease Control and Prevention, ~ (2013)
- Sohn KM, "Duration of colonization and risk factors for prolonged carriage of vancomycin-resistant enterococci after discharge from the hospital", Int J Infect Dis, 17, pp.e240~e246 (2013)
- Korea Centers for Disease Control and Prevention, "Healthcare associated disease control management guideline", Korea Centers for Disease Control and Prevention, ~ (2016)
