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Medicare reimbursement for home infusion therapy: a contributor to the development of community acquired vancomycin-resistant enterococci?

Vancomycin is a bacteriocidal antibiotic widely used to treat gram-positive infections, including methicillin-resistant Staphylococcus aureus. During the past 5 years, there have been increasingly frequent reports of infections caused by enterococci species resistant to vancomycin. Until recently, this was a phenomenon limited almost exclusively to the hospital. Presently, there are reports of vancomycin-resistant enterococci developing in the outpatient and home care population. The intent of this article is to present one possible explanation for this trend in the hope that further research will be stimulated.