Antianaerobic Antibiotic Therapy Promotes Overgrowth of Antibiotic-Resistant, Gram-Negative Bacilli and Vancomycin-Resistant Enterococci in the Stool of Colonized Patients

Abstract

AbstractBackground and Objective:Antianaerobic antibiotic therapy promotes persistent high-density growth of vancomycin-resistant enterococci (VRE) in the stool of colonized patients. We tested the hypothesis that antibiotic regimens with potent antianaerobic activity promote overgrowth of coexisting antibiotic-resistant, gram-negative bacilli in the stool of VRE-colonized patients.Design:Eight-month prospective study examining the effect of antibiotic therapy on the stool density of gram-negative bacilli resistant to ceftazidime, ciprofloxacin, or piperacillin/tazobactam.Setting:A Department of Veterans Affairs medical center including an acute care hospital and nursing home.Patients:All VRE-colonized patients with at least 3 stool samples available for analysis.Results:One-hundred forty stool samples were obtained from 37 study patients. Forty-nine (61%) of 80 stool samples obtained during therapy with an antianaerobic regimen were positive for an antibiotic-resistant, gram-negative bacillus, whereas only 14 (23%) of 60 samples obtained 4 or more weeks after completion of such therapy were positive (P< .001). Twenty-four (65%) of the 37 patients had one or more stool cultures positive for a gram-negative bacillus resistant to ciprofloxacin, ceftazidime, or piperacillin/tazobactam. The density of these organisms was higher during therapy with antianaerobic regimens than in the absence of such therapy for at least 2 weeks (mean ± standard deviation, 5.6 ± 1.4 and 3.9 ± 0.71 log10organisms/g;P< .001).Conclusion:Limiting the use of antianaerobic antibiotics in VRE-colonized patients may reduce the density of colonization with coexisting antibiotic-resistant, gram-negative bacilli.