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Medline ® Abstract for Reference 28

of 'Clostridium difficile in adults: Treatment'

28
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Antecedent treatment with different antibiotic agents as a risk factor for vancomycin-resistant Enterococcus.
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Carmeli Y, Eliopoulos GM, Samore MH
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Emerg Infect Dis. 2002;8(8):802.
 
We conducted a matched case-control study to compare the effect of antecedent treatment with various antibiotics on subsequent isolation of vancomycin-resistant Enterococcus (VRE); 880 in-patients; 233 VRE cases, and 647 matched controls were included. After being matched for hospital location, calendar time, and duration of hospitalization, the following variables predicted VRE positivity: main admitting diagnosis; a coexisting condition (e.g., diabetes mellitus, organ transplant, or hepatobiliary disease); and infection or colonization with methicillin-resistant Staphylococcus aureus or Clostridium difficile within the past year (independent of vancomycin treatment). After controlling for these variables, we examined the effect of various antibiotics. Intravenous treatment with third-generation cephalosporins, metronidazole, and fluoroquinolones was positively associated with VRE. In our institution, when we adjusted the data for temporo-spatial factors, patient characteristics, and hospital events, treatment with third-generation cephalosporins, metronidazole, and fluoroquinolones was identified as a risk factor for VRE. Vancomycin was not a risk factor for isolation of VRE.
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Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA. ycarmeli@caregroup.harvard.edu
PMID