Vancomycin-resistant enterococcus (VRE) in pediatric oncology patients: An analysis of potential consequences of colonization and infection

Abstract

9537 Background: VRE colonization and infection have emerged as an issue for pediatric oncology patients, but little is known about the long-term risks following initial VRE positivity in this population. The purpose of this study was to determine the risk of subsequent VRE infection in colonized or infected pediatric oncology patients and to try to identify risk factors. Methods: A retrospective analysis was performed of the 57 pediatric oncology patients who had a positive VRE culture at MSKCC from 1996–2000 and subsequently received chemotherapy and/or radiation therapy. Patients whose only subsequent treatment was allogeneic stem cell transplantation were excluded. The incidence of subsequent VRE infection was calculated using a competing risk analysis accounting for death from non-VRE causes as a competing risk. Data regarding hypothesized risk factors for subsequent VRE infections were collected. Results: Ten of the 57 patients had subsequent VRE infection, but none was the primary cause of death. The cumulative incidence of subsequent infection was 14% (7–27%, 95% confidence interval) at 1 year and 16% (9–29%, 95% confidence interval) at 2 years. Eight developed their subsequent infection within 3 months; the other 2 occurred at 15 and 30 months. A formal analysis of risk factors was not attempted due to the small number of events; however, none of the hypothesized risk factors (initial VRE colonization versus infection, number of chemotherapy or radiation therapy regimens, number of neutropenic or mucositis episodes, number of hospitalizations, number of abdominal surgeries or stem cell transplantations) appeared to differ between those who developed a subsequent infection and those who did not. Conclusions: Pediatric oncology patients with VRE colonization or initial infection are at risk for subsequent VRE infection, particularly within the first 3 months of initial diagnosis of VRE positivity. No significant financial relationships to disclose.