Summary:
Vancomycin-resistant enterococcus (VRE) are increasingly important pathogens in stem cell transplant (SCT). In all, 61 pediatric SCT patients had surveillance stool cultures for VRE between July 1999 and November 2002. When VRE was identified, the patients were placed on strict contact isolation. VRE was detected in 15 patients (24.6%). The median age was 3.6 years (range 0.6–18.5 years). Of the 15, 13 (87%) received an allogeneic transplant (six unrelated and seven related). Five of the 15 (33%) colonized patients developed VRE bacteremia. The bacteremia resolved in all five patients after therapy with quinupristin/dalfopristin; three patients required central line removal. Four patients died (38–153 days) post-SCT due to relapse or transplant complication not related to VRE. Of the 11 surviving patients, seven cleared the colonization at a median of 144 days (range 61–198 days) postcolonization. Four patients remain colonized at 68–702 days after the first positive culture. Intestinal colonization with VRE occurred commonly in pediatric SCT patients. Although the morbidity from VRE was not substantial, transplant patients were colonized for prolonged periods. Our results indicate that surveillance for VRE is an effective way to identify colonized patients and may lead to a decrease in transmission to other patients.
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References
LeClercq R, Derlot E, Duval J et al. Plasmid-mediated resistance to vancomycin and teicoplanin in Enterococcus faecium. N Engl J Med 1988; 319: 157–161.
Uttley AH, Collins CH, Naidoo J, George RC . Vancomycin-resistant enterococci. Lancet 1988; 1: 57–58.
Centers for Disease Control and Prevention. Nosocomial enterococci resistant to vancomycin – United States, 1989–1993. Morb Mortal Wkly Rep 1993; 42: 597–599.
Bakir M, Bova JL, Newell KA et al. Epidemiology and clinical consequences of vancomycin resistant enterococci in liver transplant patients. Transplantation 2001; 72: 1032–1037.
Orloff SL, Busch AMH, Olyaei AJ et al. Vancomycin-resistant enterococcus in liver transplant patients. Am J Surg 1999; 177: 418–422.
Patel R, Allen SL, Manahan JM et al. Natural history of vancomycin-resistant enterococcal colonization in liver and kidney transplant recipients. Liver Transplant 2001; 7: 27–31.
Newell KA, Millis JM, Arnow PM et al. Incidence and outcome of infection by vancomycin-resistant Enterococcus following orthotopic liver transplantation. Transplantation 1998; 65: 439–442.
Pfundstein J, Roghmann MC, Schwalbe RS et al. A randomized trial of surgical antimicrobial prophylaxis with and without vancomycin in organ transplant patients. Clin Transplant 1999; 13: 245–252.
Peetermans WE, Sebens FW, Guiot FL . Vancomycin-resistant Enterococcus faecalis in a bone-marrow transplant recipient. Scand J Infect Dis 1991; 23: 105–109.
Kapur D, Dorsky D, Feingold JM et al. Incidence and outcome of vancomycin-resistant enterococcal bacteremia following autologous peripheral blood stem cell transplantation. Bone Marrow Transplant 2000; 25: 147–152.
Koc Y, Snydman DR, Schenkein DS, Miller KB . Case report: vancomycin-resistant enterococcal infections in bone marrow transplant recipients. Bone Marrow Transplant 1998; 22: 207–209.
Edmond MB, Ober JF, Dawson JD et al. Vancomycin-resistant enterococcal bacteremia: natural history and attributable mortality. Clin Infect Dis 1996; 23: 1234–1239.
Shay KD, Maloney SA, Montecalvo MJ . Epidemiology and mortality risk of vancomycin-resistant enterococcal bloodstream infections. J Infect Dis 1995; 172: 993–1000.
Noskin GA, Cooper I, Peterson LR . Vancomycin-resistant Enterococcus faecium sepsis following persistent colonization. Arch Intern Med 1995; 155: 1445–1447.
Carretto E, Barbarini D, Locatelli F et al. Vancomycin-resistant Enterococcus faecium infection in three children given allogeneic hematopoietic stem cell transplantation: clinical and microbiological features. Haematologica 2000; 85: 1158–1164.
Gregory JJ, Small TN, Papadopoulos E et al. Influence of vancomycin-resistant enterococcus on the outcome of recipients of bone marrow transplants. Proc Am Soc Clin Oncol 1999; 18: 51a (abstract).
Schuster F, Graubner UB, Schmid I et al. Vancomycin-resistant enterococci – colonization of 24 patients on a pediatric oncology unit. Klin Pediatr 1998; 210: 261–263.
Singh-Naz N, Sleemi A, Pikis A et al. Vancomycin-resistant Enterococcus faecium colonization in children. J Clin Microbiol 1999; 37: 413–416.
Nourse C, Murphy H, Byrne C et al. Control of a nosocomial outbreak of vancomycin resistant Enterococcus faecium in a paediatric oncology unit: risk factors for colonisation. Eur J Pediatr 1998; 157: 20–27.
Kirkpatrick BD, Harrington SM, Smith D et al. An outbreak of vancomycin-dependent Enterococcus faecium in a bone marrow transplant unit. Clin Infect Dis 1999; 29: 1268–1273.
Weinstein MR, Dedier H, Brunton J et al. Lack of efficacy of oral bacitracin plus doxycycline for the eradication of stool colonization with vancomycin-resistant Enterococcus faecium. Clin Infect Dis 1999; 29: 361–363.
Wong MT, Kauffman CA, Ramoplanin VRE2 Clinical Study Group et al. Effective suppression of vancomycin-resistant Enterococcus species in asymptomatic gastrointestinal carriers by a novel glycolipodepsipeptide, ramoplanin. Clin Infect Dis 2001; 33: 1476–1482.
Hierholzer WJ, Garner JS, Adam AB . Recommendations for preventing the spread of vancomycin resistance: recommendations of the Hospital Infection Control Practices Advisory Committee (HICPAC). Am J Infect Control 1995; 23: 87–94.
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Tsiatis, A., Manes, B., Calder, C. et al. Incidence and clinical complications of vancomycin-resistant enterococcus in pediatric stem cell transplant patients. Bone Marrow Transplant 33, 937–941 (2004). https://doi.org/10.1038/sj.bmt.1704462
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DOI: https://doi.org/10.1038/sj.bmt.1704462
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