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Polyclonal Outbreak of Vancomycin-resistant Enterococcus faecium in a Pediatric Oncology Department

Iosifidis, Elias MD, MSc; Karakoula, Konstantina MD; Protonotariou, Efthimia MD, PhD; Kaperoni, Maria RN, MSc; Matapa, Eleftheria RN; Pournaras, Spyros MD, PhD; Koliouskas, Dimitrios MD, PhD; Sofianou, Danai MD, PhD; Roilides, Emmanuel MD, PhD

Journal of Pediatric Hematology/Oncology:
doi: 10.1097/MPH.0b013e318257a5d3
Original Articles
Abstract

We present a polyclonal outbreak of vancomycin-resistant enterococci (VRE) colonization in a pediatric oncology department and the role of a bundle of actions. After the occurrence of VRE bloodstream infections in 2 patients, an active surveillance of VRE colonization was started. Enhanced infection control measures and closure of the department to new admissions for the first 3 months were implemented. Among 32 patients screened for VRE, 21 were found colonized. Daily prevalence of VRE colonization among hospitalized patients ranged from 40% to 75%, but no new VRE infections occurred. Monthly incidence of VRE colonization decreased from 2.5 to 0.6 cases per 100 occupied bed-days at the end of this outbreak by the implementation of the above-mentioned measures. All VRE isolates tested were Enterococcus faecium carrying VanA gene. Pulsed field gel electrophoresis showed a polyclonal outbreak. A case-control study did not show any particular risk factors for colonization. High use of glycopeptide was noted before study outbreak that was drastically decreased during the study but only temporarily. Control of VRE in pediatric oncology departments with high colonization rates is challenging and requires a multifaceted strategy. Polyclonal spread of VRE found in this study suggests a possible effect of prior antimicrobial overuse and the critical need for antimicrobial stewardship especially in the era of multidrug-resistant bacteria.

Author Information

*3rd Department of Pediatrics, Aristotle University School of Medicine, Hippokration General Hospital

Departments of Microbiology

Pediatric Oncology

§Infection Control Team, Hippokration General Hospital, Thessaloniki

Department of Microbiology, Medical School, University of Thessaly, Larissa, Greece

Presented in part at the 27th Annual Meeting of the European Society of Pediatric Infectious Diseases, Brussels, Belgium, June 2009, (Abstract N 787).

E.I. is recipient of Greek State Scholarships Foundation (IKY). The remaining authors declare no conflict of interest.

Reprints: Emmanuel Roilides, MD, PhD, 3rd Department of Pediatrics, Aristotle University School of Medicine, Hippokration General Hospital, Konstantinoupoleos 49 GR-546 42 Thessaloniki, Greece (e-mail: roilides@med.auth.gr).

Received August 20, 2011

Accepted March 27, 2012

Copyright © 2012 Wolters Kluwer Health, Inc. All rights reserved.