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Antimicrob. Agents Chemother. doi:10.1128/AAC.01316-06
Copyright (c) 2007, American Society for Microbiology and/or the Listed Authors/Institutions. All Rights Reserved.

Acquisition of vancomycin-resistant Enterococcus rectal colonization among intensive care unit patients treated with piperacillin/tazobactam versus cefepime-containing antibiotic regimens

University of Queensland, Royal Brisbane and Women's Hospital, University of Queensland, Brisbane, Australia; Division of Infectious Diseases, University of Pittsburgh Medical Center, Pittsburgh PA; Research Service, Louis Stokes Cleveland VA Medical Center, Cleveland OH; Center for Quality Improvement Research, Louis Stokes Cleveland VA Medical Center, Cleveland, OH

^* To whom correspondence should be addressed. Email: curtisd123{at}yahoo.com.

	Abstract

In contrast to third-generation cephalosporins, beta-lactam/beta-lactamase inhibitors such as piperacillin/tazobactam have rarely been associated with vancomycin-resistant Enterococcus (VRE) colonization and infection. In mice, piperacillin/tazobactam has sufficient antienterococcal activity to inhibit establishment of colonization during treatment, but this effect has not been confirmed in patients. We prospectively evaluated acquisition of VRE rectal colonization among intensive care unit patients receiving antibiotic regimens containing piperacillin/tazobactam versus cefepime, a fourth-generation cephalosporin with minimal antienterococcal activity. Rectal swabs were obtained weekly and cultured for VRE. For 146 patients with a negative rectal swab for VRE prior to therapy, there was no significant difference in the frequency of VRE acquisition between patients receiving piperacillin/tazobactam and cefepime-containing regimens (19/72, 26.4% versus 23/74, 31.1%, respectively; P = 0.28). Of the 19 patients who acquired VRE in association with piperacillin/tazobactam, 10 (53%) developed new detection of VRE during therapy. Patients initiating cefepime-containing regimens were significantly more likely than those initiating piperacillin/tazobactam-containing regimens to have received antibiotic therapy in the prior 30 days (55/74, 74.3% versus 22/72, 30.6%; P < 0.001). These finding suggest that piperacillin/tazobactam and cefepime-containing antibiotic regimens may be associated with frequent acquisition of VRE in "real-world" intensive care unit settings. Although piperacillin/tazobactam inhibits the establishment of VRE colonization in mice when exposure occurs during treatment, our data suggest that this agent may not prevent acquisition of VRE in patients.