Original StudiesAn investigation of vancomycin-resistant Enterococcus faecium within the pediatric service of a large urban medical centerMCNEELEY, DAVID F. MD; BROWN, ARTHUR E. MD; NOEL, GARY J. MD; CHUNG, MARILYN BA; DE LENCASTRE, HERMINIA PHD Author Information From the Division of Pediatric Infectious Diseases, The New York Hospital-Cornell Medical Center (DFM, GJN), The Laboratory of Microbiology, The Rockefeller University (MC, HD), and the Infectious Disease Service, Memorial Sloan-Kettering Cancer Center (AEB), New York, NY. Accepted for publication Nov. 19, 1997. Address for reprints: David F. McNeeley, M.D., The New York-Hospital-Cornell Medical Center, Division of Pediatric Infectious Diseases, 525 E. 68th St., Box 296, New York, NY 10021. Fax: 212-746-8716; E-mail 〈[email protected]〉. The Pediatric Infectious Disease Journal: March 1998 - Volume 17 - Issue 3 - p 184-188 Buy Abstract Background. Between 1990 to 1992 and 1993 to 1995 there was a >5-fold increase (16.7% to 89.8%) in vancomycin-resistant Enterococcus faecium isolates as a percentage of all isolates of vancomycin-resistant enterococci on the pediatric units of The New York Hospital-Cornell Medical Center (NYH-CMC). A molecular epidemiologic investigation was undertaken to determine the extent to which this increase was associated with the spread of a vanA-containing clone of vancomycin-resistant E. faecium that had been previously defined in adults hospitalized at NYH-CMC or with the spread of another vanA clone that had been defined in children hospitalized on the pediatric service at Memorial Sloan-Kettering Cancer Center, which shares a common pediatric intensive care unit and pediatric house staff with NYH-CMC. Methods. Molecular genotyping of vancomycin-resistant E. faecium isolates obtained from pediatric patients from 1993 to 1995 was performed by pulsed field gel electrophoresis of chromosomal Sma I digests. Southern hybridization was performed using vanA- and vanB-specific probes. Medical records of patients were reviewed for pertinent clinical and demographic information. Results. A single vanB clone of vancomycin-resistant E. faecium was responsible for 17 (77.3%) of 22 isolates in the neonatal intensive care unit (NICU) of NYH-CMC. Two other vanB strains of vancomycin-resistant E. faecium and 2 vanA strains were identified among the 5 remaining NICU isolates. Vancomycin-resistant E. faecium isolates from the other pediatric units represented a heterogeneous population of primarily vanA strains, but vanA clonal strains previously identified from patients on adult services at NYH-CMC and from children hospitalized at Memorial Sloan-Kettering Cancer Center were not detected. Conclusion. A newly identified vanB clone was responsible for the increase in vancomycin-resistant E. faecium isolates in the NICU of NYH-CMC. The increase of vancomycin-resistant E. faecium among children hospitalized at NYH-CMC was unrelated to the spread of vancomycin-resistant E. faecium among adults in the same hospital or among children at an affiliated facility cared for by the same house staff and sharing a common pediatric intensive care unit. © Williams & Wilkins 1998. All Rights Reserved.