Skip to main content
Log in

Bacteremia in a pediatric hemodialysis unit secondary toEnterococcus fecalis

  • Original Article
  • Published:
Pediatric Nephrology Aims and scope Submit manuscript

Abstract

Bacteremia is often a serious and recurring problem in children with hemodialysis catheters. We report an outbreak ofEnterococcus bacteremia in a pediatirc hemodialysis unit occurring from June 1992 to June 1993. During this period, 18 episodes of bacteremia occurred in eight children: 11 infections were polymicrobial.Enterococcus fecalis was associated with 13 infections in five patients (8 polymicrobial). Other pathogens includedEnterobacter cloacae (5 infections),Staphylococcus (3),Staphylococcus epidermidis (2), andKlebsiella pneumoniae (2). AllEnterococcus infections occurred in patients with dual-lumen subclavian venous catheters. Skin and catheter sites were culture negative, except in one patient. Rectal swabs were positive forEnterococcus in five patients.Enterococcus was not isolated from any source within the unit. Serotypes of allEnterococcus isolates were different, except for 2 isolates in the same patient. Starting in June 1993, catheters were flushed after dialysis with vancomycin or ampicillin. Since initiating this procedure, further episodes ofEnterococcus bacteremia have not occurred. A questionnaire sent to other pediatric hemodialysis units failed to identifyEnterococcus among 26 cases of bacteremia. In conclusion: (1)Enterococcus is an unusual pathogen for hemodialysis-related bacteremia in children; (2) patients with dialysis catheters were predisposed to this infection; (3) a common source forEnterococcus could not be identified by either culture or by serotyping; (4) flushing catheters with antibiotics after dialysis was effective prevention.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Dahlberg PJ, Yutuc WR, Newcomer KL (1986) Subclavian hemodialysis catheter infections. Am J Nephrol 7: 421–427

    Google Scholar 

  2. Admirall J, Gonzalez J, Rello J, Campistol JM, Montoliu J, Puig de la Bellacas J, Revert L, Gatell JM (1989) Infection of hemodialysis catheters: incidence and mechanisms. Am J Nephrol 9: 454–459

    Google Scholar 

  3. Cheesebrough JS, Finch RG, Burder RP (1986) A prospective study of the mechanisms of infection associated with hemodialysis catheters. J Infect Dis 154: 579–589

    Google Scholar 

  4. Levin A, Mason AJ, Jindal KK, Fong IW, Goldstein MB (1991) Prevention of hemodialysis subclavian vein catheter infections by topical povidone-iodine. Kidney Int 40: 934–938

    Google Scholar 

  5. Ramos E, Morris JG, Polish L, Schalbe RS, Spar B, Thomas R, Light PD. Clinical and epidemiological features of vancomycin resistant enterococcus bacteremia in a dialysis center. Proceedings of the 27th Annual Meeting of the American Society of Nephrology, Orlando, 26–29, 1994, p. 472.

  6. Carlisle EJ, Blake P, McCarthy F, Vas S, Uldall R (1991) Septicemia in long-term jugular hemodialysis catheters: cradicating infection by changing the catheter over a guidewire. Int J Artif Organs 14: 150–153

    Google Scholar 

  7. Dimoto DT, Kennedy DJ (1987) Antibiotic treatmet of chronic central venous hemodialysis catheter infection without catheter removal. Int J Artif Organs 10: 239–240

    Google Scholar 

  8. Sheth KJM, Henrickson KJ (1993) Prevention of recurrent central venous catheter infections with a novel flush solution in a patient on long-term hemodialysis (letter). Pediatr Nephrol 7: 506

    Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Rights and permissions

Reprints and permissions

About this article

Cite this article

Hymes, L.C., Warshaw, B.L., Clowers, b. et al. Bacteremia in a pediatric hemodialysis unit secondary toEnterococcus fecalis . Pediatr Nephrol 10, 55–57 (1996). https://doi.org/10.1007/BF00863445

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Issue Date:

  • DOI: https://doi.org/10.1007/BF00863445

Key words

Navigation