Yeungnam Univ J Med.  2020 Apr;37(2):112-121. 10.12701/yujm.2019.00430.

Does oral doxycycline treatment affect eradication of urine vancomycin-resistant Enterococcus? A tertiary hospital study

Affiliations
  • 1Department of Internal Medicine, School of Medicine, Kyungpook National University, Kyungpook National University Hospital, Daegu, Korea

Abstract

Background
Vancomycin-resistant Enterococcus (VRE) has become more common in nosocomial infections, especially in urine samples. However, until now, no treatment regimen has been proven to effectively eradicate urine VRE colonization. Therefore, to evaluate the efficacy of doxycycline in eradicating urine VRE and shortening VRE isolation period, we compared VRE colony detection period between doxycycline-treated and untreated patients.
Methods
A retrospective cohort study of 83 patients with VRE colonization in urine cultures was conducted at a tertiary academic hospital from January 2011 to February 2018. Kaplan-Meier survival analysis was used to evaluate eradication rates in the treatment and non-treatment groups. Factors affecting urine VRE colonization persistence were analyzed by multiple logistic regression analysis.
Results
The overall rate of VRE eradication during the entire hospital stay was higher in the doxycycline treatment group (90.5%) than in the non-treatment group (58.1%, p=0.014). Survival analysis showed that the 5-, 10-, and 20-day cumulative eradication rates were 78.3%, 100%, and 100% in the doxycycline treatment group, and 18.5%, 45.7%, and 67.8% in the non-treatment group, respectively, thereby indicating that eradication rates were higher in the doxycycline treatment group than in the non-treatment group (p<0.001). Only doxycycline treatment was shown to affect urine VRE colonization persistence in multivariate logistic regression analysis
Conclusion
Doxycycline treatment enhanced the eradication rate of urine VRE colonization and appeared to be useful in shortening VRE isolation period.

Keyword

Doxycycline; Tetracycline; Affect; Vancomycin-resistant Enterococci

Figure

  • Fig. 1. Number of patients in the study. VRE, vancomycin-resistant Enterococcus; MIC, minimum inhibitory concentration.

  • Fig. 2. Survival period from drug administration day to confirmed vancomycin-resistant Enterococcus eradication day (p<0.001).


Reference

References

1. Faron ML, Ledeboer NA, Buchan BW. Resistance mechanisms, epidemiology, and approaches to screening for vancomycin-resistant enterococcus in the health care setting. J Clin Microbiol. 2016; 54:2436–47.
Article
2. Puchter L, Chaberny IF, Schwab F, Vonberg RP, Bange FC, Ebadi E. Economic burden of nosocomial infections caused by vancomycin-resistant enterococci. Antimicrob Resist Infect Control. 2018; 7:1.
Article
3. Kauffman CA. Therapeutic and preventative options for the management of vancomycin-resistant enterococcal infections. J Antimicrob Chemother. 2003; 51(Suppl 3):iii23–30.
Article
4. Lloyd-Smith P, Younger J, Lloyd-Smith E, Green H, Leung V, Romney MG. Economic analysis of vancomycin-resistant enterococci at a Canadian hospital: assessing attributable cost and length of stay. J Hosp Infect. 2013; 85:54–9.
Article
5. Shenoy ES, Paras ML, Noubary F, Walensky RP, Hooper DC. Natural history of colonization with methicillin-resistant Staphylococcus aureus (MRSA) and vancomycin-resistant Enterococcus (VRE): a systematic review. BMC Infect Dis. 2014; 14:177.
6. Pereira GH, Muller PR, Zanella RC, de Jesus Castro Lima M, Torchio DS, Levin AS. Outbreak of vancomycin-resistant enterococci in a tertiary hospital: the lack of effect of measures directed mainly by surveillance cultures and differences in response between Enterococcus faecium and Enterococcus faecalis. Am J Infect Control. 2010; 38:406–9.
Article
7. Weinstein MR, Dedier H, Brunton J, Campbell I, Conly JM. Lack of efficacy of oral bacitracin plus doxycycline for the eradication of stool colonization with vancomycin-resistant Enterococcus faecium. Clin Infect Dis. 1999; 29:361–6.
Article
8. Trautner BW, Grigoryan L, Petersen NJ, Hysong S, Cadena J, Patterson JE, et al. Effectiveness of an antimicrobial stewardship approach for urinary catheter-associated asymptomatic bacteriuria. JAMA Intern Med. 2015; 175:1120–7.
Article
9. Chopra I, Roberts M. Tetracycline antibiotics: mode of action, applications, molecular biology, and epidemiology of bacterial resistance. Microbiol Mol Biol Rev. 2001; 65:232–60.
Article
10. Agwuh KN, MacGowan A. Pharmacokinetics and pharmacodynamics of the tetracyclines including glycylcyclines. J Antimicrob Chemother. 2006; 58:256–65.
Article
11. Holmes NE, Charles PG. Safety and efficacy review of doxycycline. Clin Med Ther. 2009; 1:471–82.
Article
12. Gupta K, Bhadelia N. Management of urinary tract infections from multidrug-resistant organisms. Infect Dis Clin North Am. 2014; 28:49–59.
Article
13. Wong AH, Wenzel RP, Edmond MB. Epidemiology of bacteriuria caused by vancomycin-resistant enterococci: a retrospective study. Am J Infect Control. 2000; 28:277–81.
14. Drees M, Snydman DR, Schmid CH, Barefoot L, Hansjosten K, Vue PM, et al. Prior environmental contamination increases the risk of acquisition of vancomycin-resistant enterococci. Clin Infect Dis. 2008; 46:678–85.
Article
15. Olivier CN, Blake RK, Steed LL, Salgado CD. Risk of vancomycin-resistant Enterococcus (VRE) bloodstream infection among patients colonized with VRE. Infect Control Hosp Epidemiol. 2008; 29:404–9.
16. Edmond MB, Ober JF, Dawson JD, Weinbaum DL, Wenzel RP. Vancomycin-resistant enterococcal bacteremia: natural history and attributable mortality. Clin Infect Dis. 1996; 23:1234–9.
Article
17. Edmond MB, Ober JF, Weinbaum DL, Pfaller MA, Hwang T, Sanford MD, et al. Vancomycin-resistant Enterococcus faecium bacteremia: risk factors for infection. Clin Infect Dis. 1995; 20:1126–33.
Article
18. Tornieporth NG, Roberts RB, John J, Hafner A, Riley LW. Risk factors associated with vancomycin-resistant Enterococcus faecium infection or colonization in 145 matched case patients and control patients. Clin Infect Dis. 1996; 23:767–72.
Article
19. Montecalvo MA, Shay DK, Patel P, Tacsa L, Maloney SA, Jarvis WR, et al. Bloodstream infections with vancomycin-resistant enterococci. Arch Intern Med. 1996; 156:1458–62.
Article
20. Weinstock DM, Conlon M, Iovino C, Aubrey T, Gudiol C, Riedel E, et al. Colonization, bloodstream infection, and mortality caused by vancomycin-resistant enterococcus early after allogeneic hematopoietic stem cell transplant. Biol Blood Marrow Transplant. 2007; 13:615–21.
Article
21. Choi HK, Kim KH, Lee SH, Lee SJ. Risk factors for recurrence of Clostridium difficile infection: effect of vancomycin-resistant enterococci colonization. J Korean Med Sci. 2011; 26:859–64.
Article
22. Dancer SJ. The problem with cephalosporins. J Antimicrob Chemother. 2001; 48:463–78.
Article
23. Shepard BD, Gilmore MS. Antibiotic-resistant enterococci: the mechanisms and dynamics of drug introduction and resistance. Microbes Infect. 2002; 4:215–24.
Article
24. Centers for Disease Control and Prevention. Antibiotic resistance threats in the United States, 2013. Atlanta (GA): Centers for Disease Control and Prevention;2013.
25. Sohn KM, Peck KR, Joo EJ, Ha YE, Kang CI, Chung DR, et al. Duration of colonization and risk factors for prolonged carriage of vancomycin-resistant enterococci after discharge from the hospital. Int J Infect Dis. 2013; 17:e240–6.
Article
26. Korea Centers for Disease Control and Prevention. Healthcare associated disease control management guideline. Cheongju (KR): Korea Centers for Disease Control and Prevention;2016.
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