Driving forces of vancomycin-resistant E. faecium and E. faecalis blood-stream infections in children


Rates 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.

Methods:
E.

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.

Results:
Of 151 episodes of E.

faecium and E. faecalis BSI among hospitalized children

Of these, 5 (36%) were due to nosocomial transmission. Aggregate (r .19, P = 0.3) and individual-patient vancomycin-exposure (X2 = .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

Conclusions:
In 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.

Author: Maria Cecilia Di PentimaShannon ChanCarol BriodyMichelle PowerJobayer Hossain
Credits/Source: Antimicrobial Resistance and Infection Control 2014, 3:29

Published on: 2014-09-01

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