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Careful use of chloramphenicol and quinolone antibiotics may help preserve the use of chloramphenicol to treat vancomycin-resistant infections

Hospital-acquired enterococcal infections have increased markedly in the past 20 years, accounting for over 10 percent of hospital-acquired bloodstream infections that often result in death. In recent years, the broad-spectrum antibiotic, vancomycin, has been used to treat these multi-drug-resistant pathogens, which has led to the emergence of vancomycin-resistant enterococci (VRE). Chloramphenicol (CR) is one of the few antibiotics effective in the treatment of VRE bloodstream infections. However, longitudinal trends in development of chloramphenicol resistance in VRE isolates are unknown.

Careful use of CR and quinolone antibiotics can help preserve the usefulness of CR in fighting VRE infections, according to a recent study. The study was supported in part by the Agency for Healthcare Research and Quality through its Centers for Education and Research on Therapeutics (CERTs) program (HS10399). Investigators at the University of Pennsylvania CERT examined the relationship between annual hospital-wide use of specific antibiotics and antibiotic classes and CR-resistant VRE prevalence by analyzing the antimicrobial susceptibility profiles of all VRE blood isolates from 1991-2000 at one hospital.

During the 10-year study period, the prevalence of CR-resistant VRE increased from 0 to 11 percent. CR-resistant VRE prevalence was correlated only with use of CR and quinolone antibiotics (for example, ciprofloxacin and levofloxacin). If these trends continue, dependence on newer, more expensive agents will increase, caution the researchers. Their findings suggest that efforts to preserve the usefulness of CR for fighting vancomycin-resistant infections may depend on optimizing the use of CR and quinolone antibiotics.

See "Emergence of resistance to chloramphenicol among vancomycin-resistant enterococcal (VRE) bloodstream isolates," by Ebbing Lautenbach, M.D., M.P.H., Carolyn V. Gould, M.D., Lori A. LaRosa, Pharm.D., and others, in the International Journal of Antimicrobial Agents 23, pp. 200-203, 2004.

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