Vancomycin-resistant Enterococcus faecium infection in three children given allogeneic hematopoietic stem cell transplantation: clinical and microbiological features

Background and Objectives. The emergence of vancomycin-resistent enterococc i (VRE) as nosocomial pathogens is a major problem in the US; in Europe, VR E nosocomial infections are uncommon and only rarely have been reported in Pediatric or Neonatal Units. The aim of this study is to report on the clin ical and microbiological features of VRE infections in 3 children given hem atopoietic stem cell transplantation (HSCT). Patients and methods. Five episodes of vancomycin-resistant Enterococcus fa ecium (VREF) infection were diagnosed in 3 children given an allogeneic HSC T. Molecular methods, such as random amplification of polymorphic DNA (RAPD ) fingerprinting and automated ribotyping, were used in order to define the circulation of strains. Results. All the isolates were resistant to all commercially available agen ts and showed the VanA genotypic profile. All children were successfully tr eated with the combination of quinupristin/dalfopristin (QD) plus teicoplan in (TEC), although treatment was not sufficient to eradicate the micro-orga nism promptly from the gastrointestinal tract All our children are still al ive. After the first isolation of VRE, a surveillance protocol was started and we documented that the rate of colonization in children and their mothe rs was less than 1.5%. The RAPD method demonstrated the possible nosocomial transmission of one strain. Interpretation and Conclusions. Our experience :demonstrates that VRE infec tion is a life-threatening complication in children given HSCT. Prompt diag nosis of this infection and its treatment with the combination of QD and TE C can successfully manage this severe infection in profoundly immunocomprom ised I patients. (C) 2000, Ferrata Storti Foundation.