Eradication of vancomycin resistant Enterococcus faecium from a paediatriconcology unit and prevalence of colonization in hospitalized and community-based children

We previously reported an outbreak of vancomycin resistant enterococci (VRE ) in a paediatric oncology unit in December 1995 which was associated with widespread environmental contamination of the unit with VRE. We undertook t his study to evaluate the effectiveness of the infection control policy ins tituted subsequent to the outbreak and to investigate the underlying preval ence of VRE colonization in hospitalized, outpatient and community-based ch ildren. We sought to establish the molecular similarity of VRE isolates fro m the study. Stool specimens were obtained from outpatients at risk of VRE, hospital inpatients and from healthy community-based children. VRE coloniz ation was eradicated from the inpatient unit within 11 months, but in outpa tients, 16 months after the outbreak, 4 of 137 (2.9%) attending oncology ou tpatients, 5 of 65 (7.7%) with cystic fibrosis and 1 of 12 (8.3%) with live r disease were found to be colonized with VRE. The isolates were all Entero coccus faecium, Van A phenotype except one E, casseliflavus of the Van C ph enotype, Ail were unique in SmaI DNA macrorestriction patterns with the exc eption of two isolates, which were similar to the original outbreak strain and three further isolates of a single strain but which differed from the o utbreak strain. Of 315 hospital inpatients, 2.5% were colonized with VRE of the Van C resistance phenotype but VRE was not detected in 116 healthy, co mmunity-based children. We conclude that effective strategies can successfu lly control spread of VRE but despite a low prevalence of VRE colonization in hospital patients and in community-based children, outbreaks can occur w hen infection control practices are not optimal. Continued vigilance to det ect VRE and limit spread within hospitals is therefore necessary.