VANCOMYCIN-RESISTANT ENTEROCOCCUS-FAECIUM ON A PEDIATRIC ONCOLOGY WARD - DURATION OF STOOL SHEDDING AND INCIDENCE OF CLINICAL INFECTION

Objective. To determine the duration of stool shedding and incidence o f clinical infection among pediatric oncology patients colonized with vancomycin-resistant Enterococcus faecium (VRE) in our institution. Me thods. Stool cultures were obtained from all patients admitted from Ma y 15 to August 2, 1994. Patients were followed for evidence of clinica l VRE infection and surveillance stool results through August 15, 1995 . Genetic relatedness of stool-clinical isolate pairs and serial stool samples was evaluated using pulsed field gel electrophoresis. Results . Twenty-three (32%) of 73 screened patients were colonized with VR;E. Eight (35%) of the colonized patients cleared VRE from stool; 10 (43% ) were persistent carriers, excreting organisms for 19 to 331 days (me dian, 112 days); and 5 patients had an insufficient number of stools t o determine length of carriage. Persistent carriers had a median of 6 hospital readmissions; 8 of 10 were positive at first or second readmi ssion. Clinical VRE infection developed in 6 of 73 patients (annual in cidence, 8.2%). Clinical cases had more days of neutropenia between co lonization and infection than colonized patients during a comparable f ollow-up (49 vs. 16 days, P = 0.04). Five of 6 stool-clinical isolate pairs were identical by pulsed field gel electrophoresis. Serial stool s hom 6 of 7 patients (collected 20 to 343 days apart) were identical by pulsed field gel electrophoresis. Conclusion. Persistent gastrointe stinal colonization with VRE is common among pediatric oncology patien ts. Carriage of the same VRE clone for up to 1 year was demonstrated. In the majority of cases invasive and colonizing isolates were identic al by DNA fingerprinting techniques, suggesting that the colonizing VR E was the source of infection. Intermittent excretion of organisms in stool makes vigilant tracking and immediate isolation of such patients crucial to control efforts. Prolonged neutropenia may increase the ri sk of developing clinical infection among VRE-colonized patients.