Abstract
Objective:To investigate the clinical impact of vancomycin-resistant enterococci (VRE) colonization in patients with hematologic malignancies and associated risk factors.Materials and Methods:Patients colonized and infected with VRE were identified from an institutional surveillance database between January 2010 and December 2013. A retrospective case-control study was performed to identify the risk factors associated with development of VRE infection in VRE-colonized patients.Results:Fecal VRE colonization was documented in 72 of 229 children (31.4%). Seven VRE-colonized patients developed subsequent systemic VRE infection (9.7%). Types of VRE infections included bacteremia (n=5), urinary tract infection (n=1), and meningitis (n=1). Enterococcus faecium was isolated in all VRE infections. Multivariate analysis revealed severe neutropenia and previous bacteremia with another pathogen as independent risk factors for VRE infection development in colonized patients [odds ratio (OR): 35.4, confidence interval (CI): 1.7-72.3, p=0.02 and OR: 20.6, CI: 1.3-48.6, p=0.03, respectively]. No deaths attributable to VRE occurred.Conclusion:VRE colonization has important consequences in pediatric cancer patients.
Highlights
Children with cancer are at high risk of developing systemic infections by the microorganisms that colonize their own intestinal system [1,2]
Limited data exist on the incidence of subsequent Vancomycin-resistant enterococci (VRE) infection development among VRE-colonized pediatric cancer patients and associated risk factors, which were investigated in this study
Species determination could be performed in 32 VRE-colonized patients: Enterococcus faecium was isolated in 28 patients, Enterococcus gallinarum in 2 patients, and nontypeable Enterococcus in 2 patients
Summary
Patients colonized and infected with VRE were identified from an institutional surveillance database between January 2010 and December 2013. A retrospective case-control study was performed to identify the risk factors associated with development of VRE infection in VRE-colonized patients. All patients admitted to the pediatric hematology/oncology ward were sampled within 48-72 h after admission and weekly thereafter as part of institutional rectal VRE surveillance. An infection control nurse assigned by the Hospital Infection Control Committee (HICC) prospectively tracked the results of rectal surveillance and all health care-associated infections occurring in the hematology/oncology ward. VRE-colonized and VRE-infected patients were identified from the HICC surveillance database retrospectively. To identify the risk factors associated with VRE infection occurrence in a colonized patient, a retrospective case-control study was performed.
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