Vancomycin, enterococci resistant

Problems of recent years involving listeriosis, salmonellosis, giardiasis and Legionnaire s disease have received attention, as have the re-emergence of tuberculosis and the importance of methicillin-resistant Staphylococcus aureus (MRSA) and vancomycin-resistant enterococci (VRE). 

If the isolate is determined to be vancomycin-resistant, it is most important to know the exact species because some of the treatment options, such as quinupristin/dalfopristin, are not active against E. faecalis. Currently, the treatment options for vancomycin-resistant enterococci (VRE) are not well established by clinical studies or patient experience. The treatment recommendations for vancomycin-resistant E. faecium include linezolid or quinupristin/dalfopristin for a minimum of 8 weeks. However, newer agents, such as daptomycin, may provide another option for treatment for either enterococci species (E. faecium and E. faecalis). Additionally, guidelines suggest the use of imipenem-cilistatin plus ampicillin or ceftriaxone plus ampicillin for the treatment of E. faecalis with a minimum of 8 weeks of therapy. Consultation with an infectious diseases specialist is recommended. 

Collignon P.J. (1999). Vancomycin-resistant enterococci and use of avoparcin in animal feed is there a link Med J Austral, 21, 144-146. 

The two most frequently used antibiotics are metronidazole and vancomycin. Metronidazole is recommended as first-line therapy because of the risk of development of vancomycin-resistant enterococci with vancomycin use, as well as its much higher cost. Metronidazole and vancomycin have similar efficacy, though in one study, symptoms resolved sooner with vancomycin [61]. Metronidazole is given orally for 10 days, at a dose of 1 g per day. Vancomycin is given orally for 10 days doses vary from 500 mg/day to 2 g/day. For mild to moderately severe CDAD, low-dose vancomycin is as effective as high-dose vancomycin. Vancomycin use is generally restricted to... 

Vancomycin-resistant enterococci, particularly E. faecium, are becoming more common. 

Initial therapy with trimethoprim-sulfamethoxazole appears to be effective for CA-MRSA and should be considered in geographic areas in which CA-MRSA are commonly encountered. Alternative agents for documented infections with resistant gram-positive bacteria such as methicil-lin-resistant staphylococci and vancomycin-resistant enterococci include linezolid, quinupristin/dalfopristin, daptomycin, and tigecycline. 

Nicas, T.I. et al. Semisynthetic glycopeptide antibiotics derived from LY264826 active against vancomycin-resistant enterococci, Antimicrob. Agents Chemother., 40, 2194, 1996. 

The combined synergistic effects of cyclo(Leu-Pro) and cyclo(Phe-Pro) were effective against five vancomycin-resistant enterococci (VRE) strains Enterococcus faecium (K-99-38), E. faecalis (K-99-17), E. faecalis (K-99-258), E. faecium (K-01-312), and E. faecalis (K-01-511) with MIC values of 0.25—1 mgl . It also showed activity against E. coli, Staphylococcus aureus. Micrococcus luteus, Candida albicans, and Cryptococcus neoformans with MIC values of 0.25—0.5 mg 1. This combination also showed mutagenic activity against Salmonella typhimurium TA98 and TAIOO strains in a Salmonella mutation assay. ... 

Araujo C, Torres C, Silva N et al (2010) Vancomycin-resistant enterococci from Portuguese waste water treatment plants. J Basic Microbiol 50(6) 605-609... 

Aminomethyl- cyclines Amino- methyl- cycline MK-2764 (PTK-0796 BAY 73-7388) (153) Antibacterial (broad spectrum antibiotic against MRS A, MDR Streptococcus pneumoniae and vancomycin-resistant enterococci) Inhibits bacterial protein synthesis Phase III (treatment of hospital infections in both oral and i.v. injectable formulations) Paratek/Novartis 810... 

OXYGEN, OXIDES 0X0 ANIONS Vancomycin-resistant enterococci, d-ALANYL-d-ALANINE LIGASE VAN DER WAALS FORCES VANT HOFF RELATIONSHIP COLLISION THEORY ARRHENIUS LAW TRANSITION-STATE THEORY TEMPERATURE DEPENDENCE VANT HOFF S LAWS VARIANCE... 

For C. difficile colitis oral or i.v. metronidazole is advised for at least 14 days. Shorter duration will increase the relapse-rate. Oral vancomycin is equally effective but more expensive and the frequent use of vancomycin in some countries has been associated with an increase in vancomycin-resistant enterococci and staphylococci. 

B) Seek the newly approved drug linezolid for possibility of vancomycin-resistant enterococci (VRE)... 

MRSA = methicillin-resistant Streptococcus aureus, MRSE = methicillin-resistant Staphylococcus epidermitis, PRSP = peniciUin-resistant Streptococcus pneumoniae, and VRE = vancomycin-resistant enterococci. 

Borgen K., G.S. Simonsen, A. Sundsfjord, Y. Wasteson, 0. Olsvik, and H. Kruse (2000). Continuing high prevalence of VanA-type vancomycin-resistant enterococci on Norwegian poultry farms three years after avoparcin was banned. Journal of Applied Microbiology 89 478 85. 

Laukova A. (2000). Vancomycin-resistant enterococci isolates from the rumen content of deer. Microbios 97 95-101. 

Murray B.E. (1997). Vancomycin-resistant enterococci. American Journal of Medicine 101 284-293. 

Simonsen G.S., H. Haaheim, K.H. Dahl, H. Kruse, A. Lovseth, O. Olsvik, and A. Sundsfjord (1998). Transmisssion of vanA-type vancomycin-resistant enterococci and vanA resistance elements between chicken and humans at avoparcin-exposed farms. Microbial Drug Resistance—Mechanisms Epidemiology and Disease 4 313-318. 

Oral vancomycin, 0.125-0.25 g every 6 hours, is used to treat antibiotic-associated enterocolitis caused by C difficile. Because of the emergence of vancomycin-resistant enterococci and the selective pressure of oral vancomycin for these resistant organisms, metronidazole had been preferred as initial therapy over the last two decades. However, recent clinical data suggest that vancomycin is associated with a better clinical response than metronidazole for more severe cases of C difficile enterocolitis. Therefore, oral vancomycin may be used as a first line treatment for severe cases or for cases that fail to respond to metronidazole. 

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