Cheng VCC, Chen JHK, Tai JWM, Wong SCY, Poon RWS, Hung IFN, To KKW, Chan JFW, Ho PL, Lo CM, Yuen KY. Decolonization of gastrointestinal carriage of vancomycin-resistant Enterococcus faecium: case series and review of literature.
BMC Infect Dis 2014;
14:514. [PMID:
25248287 PMCID:
PMC4180964 DOI:
10.1186/1471-2334-14-514]
[Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2014] [Accepted: 09/08/2014] [Indexed: 12/16/2022] Open
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.
Case presentation
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.
Conclusion
This strategy should be further studied in settings of low VRE endemicity with limited isolation facilities.
Electronic supplementary material
The online version of this article (doi:10.1186/1471-2334-14-514) contains supplementary material, which is available to authorized users.
Collapse