Results of Four-Year Rectal Vancomycin-Resistant Enterococci Surveillance in a Pediatric Hematology-Oncology Ward: From Colonization to Infection

Aktürk, Hacer; Sütçü, Murat; Somer, Ayper; Karaman, Serap; Acar, Manolya; Ünüvar, Ayşegül; Anak, Sema; Karakaş, Zeynep; Özdemir, Aslı; Sarsar, Kutay; Aydın, Derya; Salman, Nuran

doi:10.4274/tjh.2015.0368

Cited by 11 publications

(6 citation statements)

References 19 publications

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“…Regarding possible differences between VREfm-colonised and VREfm-infected patients, the presence of a temporary artificial stoma, a recent surgical procedure, previous treatment with carbapenems, preceding chemotherapy and underlying haemato-oncological disease were significantly associated with the development of clinical symptoms. These findings are in line with current studies, identifying preterm babies as well as immunosuppressed paediatric intensive care patients—in particular children with a haematological/oncological diagnosis—as a high-risk population for VREfm-C and VREfm-I [ 19 , 20 , 35 , 64 – 67 ]. High exposure to antibiotics, especially third-generation cephalosporins, seems to further increase the risk [ 19 , 35 , 68 ].…”

Section: Discussionsupporting

confidence: 91%

Epidemiological and genetic characteristics of vancomycin-resistant Enterococcus faecium isolates in a University Children's Hospital in Germany: 2019 to 2020

Trautmannsberger

Kolberg

Meyer-Buehn

et al. 2022

Antimicrob Resist Infect Control

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Background Vancomycin-resistant Enterococcus faecium (VREfm) strains are one of the most important pathogens causing nosocomial infections in Germany. Due to limited treatment options and an increased risk for acquisition in immunocompromised children, surveillance to monitor occurrence of VREfm in paediatric clinical facilities is of critical importance. Following an unusual accumulation of VREfm positive patients between April 2019 and August 2020 at Dr. von Hauner Children’s Hospital in Munich, Germany, our study aimed to identify dynamics and routes of transmission, and analyse the affected population in view of previously described host risk factors for VREfm colonisation or infection. Methods The hospital database was used to collect epidemiological and clinical data of VREfm cases. Descriptive statistical analyses were conducted to outline patient characteristics and depict possible differences between VREfm-colonised and -infected children. An outbreak investigation determining genetic relatedness among VREfm isolates was performed by core genome multilocus sequence typing (cgMLST). To examine potential transmission pathways, results of genome analysis were compared with epidemiological and clinical data of VREfm positive patients. Results VREfm acquisition was documented in a total of 33 children (< 18 years). Seven VREfm-colonised patients (21.2%), especially those with a haemato-oncological disease (4/7; p = 0.011), showed signs of clinical infection. cgMLST analysis revealed seven distinct clusters, demonstrating a possible connection within each clonal lineage. Additional eight singletons were identified. Comparison with epidemiological and clinical data provided strong evidence for a link between several VREfm positive patients within the hospital. Conclusions A nosocomial spread—at least in part—was the most likely reason for the unusual accumulation of VREfm cases. The study highlights that there is a constant need to increase efforts in hygiene measures, infection control and antibiotic stewardship to combat VREfm transmission events within German paediatric hospitals. Continuous monitoring of adherence to respective policies might reduce the occurrence of clustered cases and prevent future outbreaks.

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Section: Discussionsupporting

confidence: 91%

Epidemiological and genetic characteristics of vancomycin-resistant Enterococcus faecium isolates in a University Children's Hospital in Germany: 2019 to 2020

Trautmannsberger

Kolberg

Meyer-Buehn

et al. 2022

Antimicrob Resist Infect Control

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“…in hospitalized children. Unfortunately, in recent decades there has been an increase in vancomycin‐resistant enterococci (VRE) in pediatric patients, which has a severe impact on children . This is a significant problem at Children's Hospital of Nanjing Medical University, and efficient and selective antibiotic treatment should be initiated for isolated Enterococcus spp.…”

Section: Discussionmentioning

confidence: 99%

“…Unfortunately, in recent decades there has been an increase in vancomycin-resistant enterococci (VRE) in pediatric patients, which has a severe impact on children. 16 This is a significant problem at Children's Hospital of Nanjing Medical University, and efficient and selective antibiotic treatment should be initiated for isolated Enterococcus spp. With regard to E. coli, which was the second most common isolated pathogen in the present study, two common and cheap antibiotics (amikacin and piperacillin/tazobactam) were found to be highly effective and are recommended for use.…”

Section: Discussionmentioning

confidence: 99%

Etiology and antimicrobial resistance patterns in pediatric urinary tract infection

Wang

Sha

et al. 2018

Pediatrics International

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“…Also studied were three non-fermenters with 5/144 (3%) studies about Acinetobacter baumannii [82,140–143], 4/144 (3%) studies about Pseudomonas aeruginosa [83,84,144,145], and 5/144 (3%) studies about Stenotrophomonas maltophilia [85–88,146], often specified as either multidrug- or extensively drug-resistant. We also found several studies focusing on four well-known healthcare-associated bacteria, with 11/144 (8%) focusing on VRE [89–98,147,148], 7/144 (5%) focusing on carbapenemase-producing K. pneumoniae (KPC) [99–102,149–151], 2/144 (1%) focusing on methicillin-resistant Staphylococcus aureus (MRSA) [42,152], and 6/144 (4%) focusing on extended-spectrum beta-lactamase-producing Escherichia coli (ESBL-E) [103,104,153–156]. We also found that fungi typically resistant to antifungals were studied, 3/144 (2%) studies about Aspergillus spp.…”

Section: Resultsmentioning

confidence: 74%

Clinical outcomes of antimicrobial resistance in cancer patients: A systematic review of multivariable models

Danielsen

Franconeri

Page

et al. 2022

Preprint

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Background Infections are major causes of disease in cancer patients and pose a major obstacle to the success of cancer care. The global rise of antimicrobial resistance threatens to make these obstacles even greater and hinder continuing progress in cancer care. To prevent and handle such infections, a better understanding of the risk factors are needed. This internally funded systematic review (PROSPERO registration: CRD42021282769) aims to review what risk factors for resistant infections and deaths due to resistant infections have been investigated, and with what methodological approaches. Methods We employed two broad searches of antimicrobial resistance in cancer patients, using terms associated with antimicrobial resistant infections, in MEDLINE and Embase through Ovid, in addition to Cinahl through EBSCOhost and Web of Science Core Collection. Primary, observational studies in English from January 2015 to November 2021 on human cancer patients that explicitly modelled infection or mortality associated with antimicrobial resistance in a multivariable model were included. We extracted data on the study populations and their malignancies, risk factors, the microbial aetiology, methods for variable selection, and assessed the risk of bias using the NHLBI Study Quality Assessment Tools. Results Two searches yielded a total of 27151 unique records, of which 144 studies were included after screening and reading. Of the outcomes studied, mortality was the most common (68/144, 47%). Forty-five percent (65/144) of the studies focused on haemato-oncological patients, and 27% (39/144) studied several bacteria or fungi. Studies included a median of 200 patients and 46 events. One-hundred-and-three (72%) studies used a p-value-based variable selection. Studies included a median of seven variables in the final (and largest) model, which yielded a median of 6.9 events per variable. An in-depth example of vancomycin-resistant enterococci was reported. Conclusions We found the current research on this topic to be heterogeneous, in both the methodological and epidemiological approach. Methodological choices resulting in very diverse models made it difficult or even impossible to draw statistical inferences and summarise what risk factors were of clinical relevance. The development and adherence to more standardised protocols that build on existing literature is urgent.

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Results of Four-Year Rectal Vancomycin-Resistant Enterococci Surveillance in a Pediatric Hematology-Oncology Ward: From Colonization to Infection

Cited by 11 publications

References 19 publications

Epidemiological and genetic characteristics of vancomycin-resistant Enterococcus faecium isolates in a University Children's Hospital in Germany: 2019 to 2020

Epidemiological and genetic characteristics of vancomycin-resistant Enterococcus faecium isolates in a University Children's Hospital in Germany: 2019 to 2020

Etiology and antimicrobial resistance patterns in pediatric urinary tract infection

Clinical outcomes of antimicrobial resistance in cancer patients: A systematic review of multivariable models

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