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Chloramphenicol Resistance in Vancomycin-Resistant Enterococcal Bacteremia: Impact of Prior Fluoroquinolone Use?

Published online by Cambridge University Press:  02 January 2015

Carolyn V. Gould ,
Neil O. Fishman ,
Irving Nachamkin  and
Ebbing Lautenbach
Carolyn V. Gould
Affiliation:
Division of Infections Diseases, Department of Medicine, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania
Neil O. Fishman
Affiliation:
Division of Infections Diseases, Department of Medicine, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania
Irving Nachamkin
Affiliation:
Department of Pathology and Laboratory Medicine, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania
Ebbing Lautenbach*
Affiliation:
Division of Infections Diseases, Department of Medicine, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania Department of Biostatistics and Epidemiology, the Center for Clinical Epidemiology and Biostatistics, and the Center for Education and Research on Therapeutics, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania
*
Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania School of Medicine, 825 Blockley Hall, 423 Guardian Drive, Philadelphia, PA 19104-6021
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Abstract

Objective:

The prevalence of vancomycin-resistant enterococci (VRE) has increased markedly during the past decade. Few data exist regarding the epidemiology of resistance of VRE to chloramphenicol, one of the few therapeutic options.

Design:

Survey and case-control study.

Setting:

A 725-bed, tertiary-care academie medical center and a 344-bed urban community hospital.

Patients:

Hospitalized patients with blood cultures demonstrating VRE.

Methods:

We examined the trends in the prevalence of chloramphenicol resistance in VRE blood isolates at our institution from 1991 through 2002 and conducted a case-control study to identify risk factors for chloramphenicol resistance among these isolates.

Results:

From 1991 through 2002, the annual prevalence of chloramphenicol-resistant VRE increased from 0% to 12% (P < .001, chi-square test for trend). Twenty-two case-patients with chloramphenicol-resistant VRE bloodstream isolates were compared with 79 randomly selected control-patients with chloramphenicol-susceptible VRE. Independent risk factors for chloramphenicol-resistant VRE were prior chloramphenicol use (odds ratio [OR], 10.9; 95% confidence interval [CI95], 1.72-68.91; P = .01) and prior fluoroquinolone use (OR, 4.74; CI95, 1.15-19.42; P = .03). Chloramphenicol-resistant VRE isolates were more likely to be susceptible to beta-lactams and resistant to tetracycline than were chloramphenicol-susceptible VRE isolates.

Conclusions:

Significant increases in the prevalence of chloramphenicol-resistant VRE may limit the future utility of chloramphenicol in the treatment of VRE infections, and close monitoring of susceptibility trends should continue. The association between fluoroquinolone use and chloramphenicol-resistant VRE, reflecting possible co-selection of resistance, suggests that recent dramatic increases in fluoroquinolone use may have broader implications than previously recognized.

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 25 , Issue 2 , February 2004 , pp. 138 - 145
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2004

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