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Bacteremia in a pediatric hemodialysis unit secondary to Enterococcus fecalis

L C Hymes1, B L Warshaw, B Clowers

  • 1Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia 30322, USA.

Pediatric Nephrology (Berlin, Germany)
|February 1, 1996
PubMed

Insights

Enterococcus bacteremia is an unusual but serious infection in children on hemodialysis. Flushing catheters with antibiotics after dialysis effectively prevented further Enterococcus infections in a pediatric unit.

Area of Science:

  • Pediatric Nephrology
  • Infectious Diseases
  • Clinical Microbiology

Background:

  • Bacteremia is a significant complication for pediatric patients undergoing hemodialysis, particularly those with central venous catheters.
  • An outbreak of Enterococcus bacteremia occurred in a pediatric hemodialysis unit between June 1992 and June 1993.

Purpose of the Study:

  • To investigate an outbreak of Enterococcus bacteremia in a pediatric hemodialysis unit.
  • To identify the source and contributing factors of the outbreak.
  • To evaluate the effectiveness of a new preventive measure.

Main Methods:

  • Retrospective analysis of 18 bacteremia episodes in eight children over a 13-month period.
  • Cultures of blood, catheter sites, and rectal swabs were performed.
  • Enterococcus isolates were characterized by serotyping.
  • A post-dialysis catheter flushing protocol with vancomycin or ampicillin was implemented.

Main Results:

  • Enterococcus was the primary pathogen in 13 of 18 episodes, often in polymicrobial infections.
  • All Enterococcus infections were associated with dual-lumen subclavian venous catheters.
  • No common environmental or patient source was identified through cultures or serotyping.
  • Catheter flushing with antibiotics led to the cessation of Enterococcus bacteremia episodes.

Conclusions:

  • Enterococcus is an uncommon cause of bacteremia in pediatric hemodialysis patients.
  • Dialysis catheters predispose children to Enterococcus infections.
  • Preventive measures, such as antibiotic catheter flushing, can be effective in controlling outbreaks.
Abstract

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