Oral antimicrobial options for vancomycin-resistant Enterococcus isolates in urine culture
Bibliographic record
Abstract
Objectives: The present study aimed to investigate the susceptibility profiles of vancomycin-resistant Enterococcus isolates in urine culture to create an antibiogram to guide selection of oral antimicrobials in British Columbia (BC), Canada. Methods: An audit was conducted on all urine cultures reported from January 1, 2021, to December 31, 2023, in LifeLabs BC microbiology laboratories. Enterococcus species in urine were routinely tested with ampicillin, ciprofloxacin, nitrofurantoin, tetracycline, and vancomycin. Linezolid and fosfomycin were tested in selected cases. Results: Three hundred and thirty-five vancomycin-resistant Enterococcus faecium, 47 vancomycin-resistant Enterococcus faecalis, 48 Enterococcus gallinarum, 25 Enterococcus casseliflavus, and no Enterococcus flavescens isolates were reported in urine culture. Vancomycin-resistant E. faecium isolates were >90% susceptible to linezolid, but <15% susceptible to ampicillin, ciprofloxacin, nitrofurantoin, and tetracycline. Vancomycin-resistant E. faecalis isolates were >90% susceptible to ampicillin, linezolid, and nitrofurantoin, but <10% susceptible to ciprofloxacin and tetracycline. E. casseliflavus isolates were >90% susceptible to ampicillin, nitrofurantoin, and tetracycline. E. gallinarum isolates were >90% susceptible to ampicillin and nitrofurantoin. In the seven and 263 selected cases of vancomycin-resistant E. faecium and E. faecalis, respectively, fosfomycin susceptibility rates were 57% and 86%, respectively. Conclusions: Ampicillin and nitrofurantoin may be considered for urinary tract infections secondary to vancomycin-resistant E. faecalis, E. casseliflavus, and E. gallinarum. Tetracycline may also be considered for E. casseliflavus. Linezolid remained to be the only reliable oral antimicrobial for vancomycin-resistant E. faecium.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.003 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.001 | 0.000 |
| Scholarly communication | 0.001 | 0.000 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.002 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".