Abstract
BackgroundRates of invasive vancomycin-resistant Enterococcus (VRE) in the USA remains on the rise. Efforts to control vancomycin use and nosocomial transmission have had limited success in halting the spread of this pathogen. The role of antibiotic exposure remains a topic of controversy. We evaluated the association between emergence of VRE-blood-stream infections (BSI), aggregate and individual-patient vancomycin- exposure, and clonal transmission of VRE at an academic pediatric tertiary care hospital.MethodsE. faecium and E. faecalis isolates recovered from blood specimens from hospitalized children from 2003–2010 were retrieved from the microbiology database. Aggregate vancomycin use and individual-patient vancomycin exposure 6 months preceding each event of bacteremia were recorded. Pulse-field electrophoresis was performed on selected VRE isolates.ResultsOf 151 episodes of E. faecium and E. faecalis BSI among hospitalized children <18 years of age, 9% (14) were due to VRE. Of these, 5 (36%) were due to nosocomial transmission. Aggregate (r .19, P = 0.3) and individual-patient vancomycin-exposure (X 2 = .26; P = .87) were not associated with VRE-BSI. On bivariate analysis, OR for developing VRE-BSI among patients infected with clonal isolates was 36 (P < .0001). Infection control interventions, rather than antimicrobial stewardship interventions to decrease vancomycin use, proved to be effective in reducing the rates of VRE-BSI.ConclusionsIn our experience, VRE-BSI was associated with nosocomial transmission and was independent of aggregate and individual-patient vancomycin-exposure. Molecular epidemiology is a crucial tool to differentiate the role of nosocomial transmission and antibiotic exposure in the emergence of invasive VRE infections among hospitalized children.
Highlights
Rates of invasive vancomycin-resistant Enterococcus (VRE) in the USA remains on the rise
E. faecium and E. faecalis blood-stream infections From April 1st, 2003 to March 31st, 2010, we identified 151 episodes of E. faecium and E. faecalis bacteremia in 101 pediatric patients (46 females; 55 males)
The majority (137 of 151; 88%) of Enterococci blood-stream infections (BSI) were due to vancomycin-susceptible E. faecium and E. faecalis (VSE)
Summary
Rates of invasive vancomycin-resistant Enterococcus (VRE) in the USA remains on the rise. We evaluated the association between emergence of VRE-blood-stream infections (BSI), aggregate and individual-patient vancomycin- exposure, and clonal transmission of VRE at an academic pediatric tertiary care hospital. The use of selected antibiotics such as vancomycin, expanded-spectrum cephalosporins, and agents with potent anaerobic activity has been found to promote individual patients to gastrointestinal colonization with VRE [4]. We sought to evaluate the association between aggregate and individual-patient vancomycin-exposure, clonal transmission among hospitalized children and rates of VRE-BSI at a tertiary-care children hospital. To the best of our knowledge this is the first study addressing individual-patient and aggregate vancomycin exposure and nosocomial transmission using pulse-field electrophoresis to determine risk factors associated with VRE-BSI in pediatric patients
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