Decolonization of gastrointestinal carriage of vancomycin-resistant Enterococcus faecium: case series and review of literature

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• 作者：Vincent CC Cheng (11) (12)
  Jonathan HK Chen (11)
  Josepha WM Tai (12)
  Sally CY Wong (11)
  Rosana WS Poon (11)
  Ivan FN Hung (13)
  Kelvin KW To (11)
  Jasper FW Chan (11)
  Pak-Leung Ho (11)
  Chung-Mau Lo (14)
  Kwok-Yung Yuen (11)
  
  11. Department of Microbiology ; Queen Mary Hospital ; Hong Kong Special Administrative Region ; Hong Kong ; China
  12. Infection Control Team ; Queen Mary Hospital ; Hong Kong Special Administrative Region ; Hong Kong ; China
  13. Department of Medicine ; Queen Mary Hospital ; Hong Kong Special Administrative Region ; Hong Kong ; China
  14. Department of Surgery ; Queen Mary Hospital ; Hong Kong Special Administrative Region ; Hong Kong ; China
  
• 关键词：Vancomycin ; resistant enterococci ; Decolonization ; Bowel preparation ; Polyethylene glycol ; Linezolid ; Daptomycin ; Lactobacillus rhamnosus GG
• 刊名：BMC Infectious Diseases
• 出版年：2014
• 出版时间：December 2014
• 年：2014
• 卷：14
• 期：1
• 全文大小：604 KB
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  3. Cheng, VC, Chan, JF, Tai, JW, Ho, YY, Li, I, To, KK, Ho, PL, Yuen, KY (2009) Successful control of vancomycin-resistant Enterococcus faecium outbreak in a neurosurgical unit at non-endemic region. Emerg Health Threats J 2: pp. e9
  4. Cheng, VC, Tai, JW, Ng, ML, Chan, JF, Wong, SC, Li, IW, Chung, HP, Lo, WK, Yuen, KY, Ho, PL (2012) Extensive contact tracing and screening to control the spread of vancomycin-resistant Enterococcus faecium ST414 in Hong Kong. Chin Med J (Engl) 125: pp. 3450-3457
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  6. Cheng, VC, Chan, JF, Wong, SC, Chen, JH, Tai, JW, Yan, MK, Kwan, GS, Tse, H, To, KK, Ho, PL, Yuen, KY (2013) Proactive infection control measures to prevent nosocomial transmission of carbapenem-resistant Enterobacteriaceae in a non-endemic area. Chin Med J (Engl) 126: pp. 4504-4509
  7. O鈥橠onovan, CA, Fan-Havard, P, Tecson-Tumang, FT, Smith, SM, Eng, RH (1994) Enteric eradication of vancomycin-resistant Enterococcus faecium with oral bacitracin. Diagn Microbiol Infect Dis 18: pp. 105-109 CrossRef
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  24. The pre-publication history for this paper can be accessed here:http://www.biomedcentral.com/1471-2334/14/514/prepub
  
• 刊物主题：Infectious Diseases; Parasitology; Medical Microbiology; Tropical Medicine; Internal Medicine;
• 出版者：BioMed Central
• ISSN：1471-2334

文摘

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.