PMID- 8895914
OWN - NLM
STAT- MEDLINE
DCOM- 19970121
LR  - 20190818
IS  - 0891-3668 (Print)
IS  - 0891-3668 (Linking)
VI  - 15
IP  - 10
DP  - 1996 Oct
TI  - Vancomycin-resistant Enterococcus faecium on a pediatric oncology ward: duration 
      of stool shedding and incidence of clinical infection.
PG  - 848-54
AB  - OBJECTIVE: To determine the duration of stool shedding and incidence of clinical 
      infection among pediatric oncology patients colonized with vancomycin-resistant 
      Enterococcus faecium (VRE) in our institution. METHODS: Stool cultures were 
      obtained from all patients admitted from May 15 to August 2, 1994. Patients were 
      followed for evidence of clinical VRE infection and surveillance stool results 
      through August 15, 1995. Genetic relatedness of stool-clinical isolate pairs and 
      serial stool samples was evaluated using pulsed field gel electrophoresis. 
      RESULTS: Twenty-three (32%) of 73 screened patients were colonized with VRE. 
      Eight (35%) of the colonized patients cleared VRE from stool; 10 (43%) were 
      persistent carriers, excreting organisms for 19 to 331 days (median, 112 days); 
      and 5 patients had an insufficient number of stools to determine length of 
      carriage. Persistent carriers had a median of 6 hospital readmissions; 8 of 10 
      were positive at first or second readmission Clinical VRE infection developed in 
      6 of 73 patients (annual incidence, 8.2%). Clinical cases had more days of 
      neutropenia between colonization and infection than colonized patients during a 
      comparable follow-up (49 vs. 16 days, P = 0.04). Five of 6 stool-clinical isolate 
      pairs were identical by pulsed field gel electrophoresis. Serial stools from 6 of 
      7 patients (collected 20 to 343 days apart) were identical by pulsed field gel 
      electrophoresis. CONCLUSION: Persistent gastrointestinal colonization with VRE is 
      common among pediatric oncology patients. Carriage of the same VRE clone for up 
      to 1 year was demonstrated. In the majority of cases invasive and colonizing 
      isolates were identical by DNA fingerprinting techniques, suggesting that the 
      colonizing VRE was the source of infection. Intermittent excretion of organisms 
      in stool makes vigilant tracking and immediate isolation of such patients crucial 
      to control efforts. Prolonged neutropenia may increase the risk of developing 
      clinical infection among VRE-colonized patients.
FAU - Henning, K J
AU  - Henning KJ
AD  - Infectious Disease Service, Memorial Sloan-Kettering Cancer Center, New York, NY, 
      USA.
FAU - Delencastre, H
AU  - Delencastre H
FAU - Eagan, J
AU  - Eagan J
FAU - Boone, N
AU  - Boone N
FAU - Brown, A
AU  - Brown A
FAU - Chung, M
AU  - Chung M
FAU - Wollner, N
AU  - Wollner N
FAU - Armstrong, D
AU  - Armstrong D
LA  - eng
PT  - Journal Article
PT  - Research Support, Non-U.S. Gov't
PL  - United States
TA  - Pediatr Infect Dis J
JT  - The Pediatric infectious disease journal
JID - 8701858
RN  - 0 (Anti-Bacterial Agents)
RN  - 6Q205EH1VU (Vancomycin)
SB  - IM
CIN - Pediatr Infect Dis J. 1996 Oct;15(10):845-7. PMID: 8895913
MH  - Anti-Bacterial Agents/*pharmacology
MH  - *Carrier State/epidemiology
MH  - Child
MH  - Drug Resistance, Microbial
MH  - Electrophoresis, Gel, Pulsed-Field
MH  - Enterococcus faecium/*drug effects/isolation & purification
MH  - Feces/microbiology
MH  - Female
MH  - Gram-Positive Bacterial Infections/drug therapy/*epidemiology
MH  - Humans
MH  - Male
MH  - Neoplasms/complications
MH  - Neutropenia/complications
MH  - Oncology Service, Hospital
MH  - Risk Factors
MH  - Vancomycin/*pharmacology
EDAT- 1996/10/01 00:00
MHDA- 1996/10/01 00:01
CRDT- 1996/10/01 00:00
PHST- 1996/10/01 00:00 [pubmed]
PHST- 1996/10/01 00:01 [medline]
PHST- 1996/10/01 00:00 [entrez]
AID - 10.1097/00006454-199610000-00004 [doi]
PST - ppublish
SO  - Pediatr Infect Dis J. 1996 Oct;15(10):848-54. doi: 
      10.1097/00006454-199610000-00004.