Prevalence of Intestinal Colonization with Vancomycin-Resistant Enterococci (VRE) and Factors Associated with Intestinal Colonization Among the Pediatric Oncology Population in a Tertiary Cancer Care Hospital in Sri Lanka
M A D P K Wijesinghe, P Gunasekara SamanmaleeAbstract
Background
Infections caused by Enterococci rank second or third among nosocomial infections worldwide. Enterococci exhibit both acquired and intrinsic antibiotic resistance. Due to this acquired resistance to vancomycin, further treatment options for enterococcal infections are limited and challenging. Vancomycin Resistant Enterococci (VRE) can be spread from person to person through contact with an infected or colonized patient either directly or indirectly from contaminated surfaces or medical instruments. Gastro intestinal colonization of VRE can lead to subsequent blood stream infections.
Objective
To determine the prevalence of intestinal colonization with VRE and factors associated with intestinal colonization in pediatric oncology population.
Methods
A hospital-based descriptive cross-sectional study was carried out over 04 months. The study population was 218 and children up to the age of 14 who were admitted to the pediatric oncology wards in the National Cancer Hospital in Sri Lanka for a variety of reasons, were enrolled. Stool cultures were performed to detect Vancomycin-resistant enterococci. For the VRE isolates species identification and the linezolid and tigecycline MIC were performed with the VITEK 2 automated identification system and antibiotic susceptibility testing methods respectively.
Results
Majority of study participants were less than 5 years of age (n=122, 56%). Predominant type of malignancy was hematological (n=162, 74.3%). Out of the 218 stool samples collected, enterococci were identified in the majority of the samples (n=206, 94.5%) and out of them, vancomycin resistance enterococci were identified only in 24 (11%) stool samples, and all belonged to the Enterococcus faecium. All VRE colonizers had hematological malignancies. All these VREs were sensitive to Tigecycline and Linezolid. The main associated risk factors included recent severe neutropenia lasting > 7 days, ICU stay, and administration of IV Vancomycin and IV Teicoplanin for more than 7 days. Patient age and sex, prolonged hospital stay or recurrent hospital admissions, and administration of 3rd generation Cephalosporins were not identified as risk factors in this study.
Conclusions
The high prevalence of VRE colonization in this study signals the emergence of VRE in pediatric cancer patients. Therefore, there should be a need to perform ongoing surveillance, prudent use of antibiotics including antimicrobial stewardship, adhere to strict contact precautions, use of personnel protective equipment and improve awareness among the health care personnel.