Department of Clinical Pharmacy, University of California-San Francisco School of Pharmacy, San Francisco, California 94143, USA.
Pharmacotherapy. 2010 Nov;30(11):1136-49. doi: 10.1592/phco.30.11.1136.
Enterococci are a common cause of urinary tract infections (UTIs) among hospitalized patients. The rising prevalence of vancomycin-resistant enterococci (VRE) is of particular concern within many institutions because of its association with increased mortality and health care costs, as well as limited treatment options. Clinicians need to differentiate between VRE-associated urinary colonization, asymptomatic bacteriuria, and UTIs in order to determine the need for treatment, optimal therapeutic options, and length of therapy. Unnecessary use of antibiotics in patients simply colonized and not infected with VRE in the urine has become a large problem in both hospitals and long-term care facilities. A PubMed-MEDLINE search was conducted to identify all English-language literature published between January 1975 and March 2010 in order to summarize diagnostic criteria and treatment options for VRE UTIs. Several antimicrobials are discussed, with the specific focus on those with the potential to treat VRE UTIs and susceptibility patterns of VRE from urinary sources: ampicillin, amoxicillin, daptomycin, doxycycline, fosfomycin, imipenem-cilastatin, linezolid, nitrofurantoin, penicillin, piperacillin, quinupristin-dalfopristin, tetracycline, and tigecycline. Recommendations for empiric treatment of enterococcal UTIs and definitive treatment of VRE UTIs, including an evidence-based treatment algorithm, are proposed. Ampicillin generally is considered the drug of choice for ampicillin-susceptible enterococcal UTIs, including VRE. Nitrofurantoin, fosfomycin, and doxycycline have intrinsic activity against enterococci, including VRE, and are possible oral options for VRE cystitis. Linezolid and daptomycin should be reserved for confirmed or suspected upper and/or bacteremic VRE UTIs among ampicillin-resistant strains. Use of other antimicrobials, such as quinupristin-dalfopristin and tigecycline, should be evaluated on a case-by-case basis due to concerns of toxicity, resistance, and insufficient supportive data. Additional clinical data are needed to determine the optimal management and duration of therapy for VRE UTIs.
肠球菌是住院患者尿路感染（UTI）的常见病因。万古霉素耐药肠球菌（VRE）的患病率不断上升，在许多医疗机构中引起了特别关注，因为它与死亡率和医疗保健成本增加以及治疗选择有限有关。临床医生需要区分 VRE 相关的尿路定植、无症状菌尿和 UTI，以便确定治疗的必要性、最佳治疗选择和治疗时间。在尿液中只是定植而未感染 VRE 的患者中不必要地使用抗生素已成为医院和长期护理机构中的一个大问题。进行了一项 PubMed-MEDLINE 检索，以确定 1975 年 1 月至 2010 年 3 月期间发表的所有英文文献，以总结 VRE UTI 的诊断标准和治疗选择。讨论了几种抗生素，重点介绍了那些有可能治疗 VRE UTI 以及来自尿液源的 VRE 的药敏模式的抗生素：氨苄西林、阿莫西林、达托霉素、多西环素、磷霉素、亚胺培南-西司他丁、利奈唑胺、呋喃妥因、青霉素、哌拉西林、奎奴普丁-达福普汀、四环素和替加环素。提出了治疗肠球菌 UTI 的经验性治疗和 VRE UTI 的确定性治疗的建议，包括基于证据的治疗算法。氨苄西林通常被认为是治疗氨苄西林敏感肠球菌 UTI 的首选药物，包括 VRE。呋喃妥因、磷霉素和多西环素对肠球菌具有固有活性，包括 VRE，并且是 VRE 膀胱炎的可能口服选择。对于氨苄西林耐药株，应保留利奈唑胺和达托霉素用于确诊或疑似的上尿路感染和/或菌血症性 VRE UTI。由于毒性、耐药性和缺乏支持性数据的问题，应根据具体情况评估其他抗生素，如奎奴普丁-达福普汀和替加环素的使用。需要更多的临床数据来确定 VRE UTI 的最佳管理和治疗时间。
