抗生素治疗对定植患者粪便中耐万古霉素肠球菌密度的影响。
Effect of antibiotic therapy on the density of vancomycin-resistant enterococci in the stool of colonized patients.
作者信息
Donskey C J, Chowdhry T K, Hecker M T, Hoyen C K, Hanrahan J A, Hujer A M, Hutton-Thomas R A, Whalen C C, Bonomo R A, Rice L B
机构信息
Infectious Diseases Section, Louis Stokes Cleveland Veterans Affairs Medical Center, Cleveland, OH 44106, USA.
出版信息
N Engl J Med. 2000 Dec 28;343(26):1925-32. doi: 10.1056/NEJM200012283432604.
BACKGROUND
Colonization and infection with vancomycin-resistant enterococci have been associated with exposure to antibiotics that are active against anaerobes. In mice that have intestinal colonization with vancomycin-resistant enterococci, these agents promote high-density colonization, whereas antibiotics with minimal antianaerobic activity do not.
METHODS
We conducted a seven-month prospective study of 51 patients who were colonized with vancomycin-resistant enterococci, as evidenced by the presence of the bacteria in stool. We examined the density of vancomycin-resistant enterococci in stool during and after therapy with antibiotic regimens and compared the effect on this density of antianaerobic agents and agents with minimal antianaerobic activity. In a subgroup of 10 patients, cultures of environmental specimens (e.g., from bedding and clothing) were obtained.
RESULTS
During treatment with 40 of 42 antianaerobic-antibiotic regimens (95 percent), high-density colonization with vancomycin-resistant enterococci was maintained (mean [+/-SD] number of organisms, 7.8+/-1.5 log per gram of stool). The density of colonization decreased after these regimens were discontinued. Among patients who had not received antianaerobic antibiotics for at least one week, 10 of 13 patients who began such regimens had an increase in the number of organisms of more than 1.0 log per gram (mean increase, 2.2 log per gram), whereas among 10 patients who began regimens of antibiotics with minimal antianaerobic activity, there was a mean decrease in the number of enterococci of 0.6 log per gram (P=0.006 for the difference between groups). When the density of vancomycin-resistant enterococci in stool was at least 4 log per gram, 10 of 12 sets of cultures of environmental specimens had at least one positive sample, as compared with 1 of 9 sets from patients with a mean number of organisms in stool of less than 4 log per gram (P=0.002).
CONCLUSIONS
For patients with vancomycin-resistant enterococci in stool, treatment with antianaerobic antibiotics promotes high-density colonization. Limiting the use of such agents in these patients may help decrease the spread of vancomycin-resistant enterococci.
背景
耐万古霉素肠球菌的定植和感染与接触对厌氧菌有活性的抗生素有关。在耐万古霉素肠球菌肠道定植的小鼠中，这些药物会促进高密度定植，而抗厌氧活性最小的抗生素则不会。
方法
我们对51例耐万古霉素肠球菌定植患者进行了为期7个月的前瞻性研究，粪便中存在该细菌可证明这一点。我们检查了抗生素治疗期间及治疗后粪便中耐万古霉素肠球菌的密度，并比较了抗厌氧菌药物和抗厌氧活性最小的药物对该密度的影响。在10例患者的亚组中，采集了环境标本（如来自被褥和衣物）的培养物。
结果
在42种抗厌氧抗生素治疗方案中的40种（95%）治疗期间，耐万古霉素肠球菌的高密度定植得以维持（每克粪便中微生物的平均[±标准差]数量为7.8±1.5 log）。这些治疗方案停止后，定植密度降低。在至少一周未接受抗厌氧抗生素治疗的患者中，开始此类治疗方案的13例患者中有10例每克粪便中的微生物数量增加超过1.0 log（平均增加2.2 log/克），而在开始使用抗厌氧活性最小的抗生素治疗方案的10例患者中，肠球菌数量平均每克减少0.6 log（两组间差异P=0.006）。当粪便中耐万古霉素肠球菌的密度至少为4 log/克时，12组环境标本培养物中有10组至少有一个阳性样本，而粪便中微生物平均数量少于4 log/克的患者的9组培养物中有1组阳性样本（P=0.002）。
结论
对于粪便中存在耐万古霉素肠球菌的患者，使用抗厌氧抗生素治疗会促进高密度定植。限制这些患者使用此类药物可能有助于减少耐万古霉素肠球菌的传播。
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