Prevalence of vancomycin-resistant enterococci among children with end-stage renal failure. Mid-European Pediatric

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H von Baum1, J Schehl, H K Geiss

  • 1Institute of Hygiene, Department of Pediatrics, University of Heidelberg, Germany. heike_von_baum@med.uni-heidelberg.de

Clinical Infectious Diseases : an Official Publication of the Infectious Diseases Society of America
|December 10, 1999
PubMed

Insights

Vancomycin-resistant enterococcus (VRE) colonization is low in pediatric end-stage renal failure (ESRF) patients in mid-Europe. Enterococci with reduced vancomycin susceptibility (ERSV) were more common, with past vancomycin use and tacrolimus therapy as risk factors.

Area of Science:

  • Microbiology
  • Nephrology
  • Infectious Diseases

Background:

  • Enterococcus species are common causes of healthcare-associated infections.
  • Vancomycin resistance in enterococci (VRE) is a growing public health concern.
  • Colonization rates of VRE and VSE in pediatric end-stage renal failure (ESRF) patients are not well-established.

Purpose of the Study:

  • To determine the prevalence of vancomycin-resistant enterococcus (VRE) and enterococci with reduced vancomycin susceptibility (ERSV) colonization in pediatric ESRF patients.
  • To identify risk factors associated with VRE and ERSV colonization in this population.
  • To assess the incidence of enterococcal infections in VRE/ERSV carriers versus non-carriers.

Main Methods:

  • A cross-sectional study screening intestinal flora from 338 pediatric ESRF patients across 13 mid-European pediatric nephrology units.
  • Patients included those undergoing hemodialysis, chronic peritoneal dialysis, or who were transplant recipients.
  • Enterococcal strains were isolated and tested for vancomycin susceptibility using minimal inhibitory concentration (MIC) breakpoints.

Main Results:

  • Enterococci were recovered from 232 patients (68.6%), with 27 strains (7.1%) showing reduced vancomycin susceptibility (MIC >4 microg/mL).
  • High-level vancomycin resistance (VRE, MIC >32 microg/mL) was found in 2 patients (0.6%), while ERSV was found in 22 patients (6.5%).
  • Past vancomycin use (P = .05) and tacrolimus therapy (P = .011) were independent risk factors for ERSV/VRE carriage. Enterococcal infections occurred similarly in carriers and non-carriers, with no VRE/ERSV infections reported.

Conclusions:

  • The prevalence of ERSV carriage is moderate, and VRE colonization is low among pediatric ESRF patients in mid-Europe.
  • Vancomycin use and tacrolimus therapy are significant risk factors for VRE/ERSV colonization.
  • Current colonization rates do not appear to increase the risk of enterococcal infections in this vulnerable pediatric population.

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