BACTEREMIA IN A PEDIATRIC HEMODIALYSIS UNIT SECONDARY TO ENTEROCOCCUS-FECALIS

Bacteremia is often a serious and recurring problem in children with h emodialysis catheters. We report an outbreak of Enterococcus bacteremi a in a pediatirc hemodialysis unit occurring from June 1992 to June 19 93. During this period, 18 episodes of bacteremia occurred in eight ch ildren; 11 infections were polymicrobial. Enterococcus fecalis was ass ociated with 13 infections in five patients (8 polymicrobial). Other p athogens included Enterobacter cloacae (5 infections), Staphylococcus (3), Staphylococcus epidermidis (2), and Klebsiella pneumoniae (2). Al l Enterococcus infections occurred in patients with dual-lumen subclav ian venous catheters. Skin and catheter sites were culture negative, e xcept in one patient. Rectal swabs were positive for Enterococcus in f ive patients. Enterococcus was not isolated from any source within the unit. Serotypes of all Enterococcus isolates were different, except f or 2 isolates in the same patient. Starting in June 1993, catheters we re flushed after dialysis with vancomycin or ampicillin. Since initiat ing this procedure, further episodes of Enterococcus bacteremia have n ot occurred. A questionnaire sent to other pediatric hemodialysis unit s failed to identify Enterococcus among 26 cases of bacteremia. In con clusion: (1) Enterococcus is an unusual pathogen for hemodialysis-rela ted bacteremia in children; (2) patients with dialysis catheters were predisposed to this infection; (3) a common source for Enterococcus co uld not be identified by either culture or by serotyping; (4) flushing catheters with antibiotics after dialysis was effective prevention.