Skip to main content

Advertisement

SpringerLink
Log in

Enterococcal bacteremia in febrile neutropenic children and adolescents with underlying malignancies, and clinical impact of vancomycin resistance

  • Original Paper
  • Published:
Infection Aims and scope Submit manuscript

Abstract

Purpose

Enterococci are a common cause of bacteremia in immunocompromised patients. Although the increase of vancomycin-resistant enterococci (VRE) makes appropriate antibiotic therapy difficult, clinical characteristics of enterococcal bacteremia and the impact of VRE infection on outcomes have rarely been reported in immunocompromised children.

Methods

We enrolled children and adolescents (< 19 years of age) with underlying malignancies who were diagnosed with enterococcal bacteremia during febrile neutropenia between 2010 and 2017. Medical records of the enrolled children were retrospectively reviewed to evaluate the clinical characteristics of enterococcal bacteremia and impact of VRE infection on outcomes.

Results

Thirty-six episodes of enterococcal bacteremia were identified in 30 patients. VRE infection was identified in 11 episodes (30.6%); the 7- and 30-day mortalities were 27.8% and 44.4%, respectively. Acute lymphoblastic leukemia (50.0%) and acute myeloid leukemia (30.6%) were the most common underlying disorders. Three (8.3%) of the patients were in complete remission, and palliative and reinduction chemotherapies were administered in 47.2% and 36.1% of episodes, respectively. Empirical antibiotic therapy was appropriate in 64.0% of patients with vancomycin-susceptible enterococcal infection and in none of the VRE-infected patients (p = 0.001). However, the 30-day mortality was not significantly different between the two patient groups (44.0% vs. 45.5%, p = 1.000).

Conclusions

Most episodes of enterococcal bacteremia occurred in advanced stages of underlying malignancies, and still showed high mortality. The prognosis seemed to be related to the underlying disease condition rather than vancomycin resistance of the isolated enterococci, although the number of enrolled patients was small.

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

Access this article

Log in via an institution

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

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. English BK, Shenep JL. Enterococcal and viridans streptococcal infections. In: Cherry JD, Harrison GJ, Kaplan SL, Steinbach WJ, Hotez PJ, editors. Feigin and Cherry’s textbook of pediatric infectious diseases. 7th edn. Philadelphia: Elsvier; 2014. pp. 1170–97.

    Google Scholar 

  2. Hoge CW, Adams J, Buchanan B, Sears SD. Enterococcal bacteremia: to treat or not to treat, a reappraisal. Rev Infect Dis. 1991;13:600–5.

    Article  CAS  PubMed  Google Scholar 

  3. Maki DG, Agger WA. Enterococcal bacteremia: clinical features, the risk of endocarditis, and management. Medicine (Baltimore). 1988;67:248–69.

    Article  CAS  Google Scholar 

  4. Christie C, Hammond J, Reising S, Evans-Patterson J. Clinical and molecular epidemiology of enterococcal bacteremia in a pediatric teaching hospital. J Pediatr. 1994;125:392–9.

    Article  CAS  PubMed  Google Scholar 

  5. Gray J, Marsh PJ, Stewart D, Pedler SJ. Enterococcal bacteraemia: a prospective study of 125 episodes. J Hosp Infect. 1994;27:179–86.

    Article  CAS  PubMed  Google Scholar 

  6. Mikulska M, Viscoli C, Orasch C, Livermore DM, Averbuch D, Cordonnier C, et al. Aetiology and resistance in bacteraemias among adult and paediatric haematology and cancer patients. J Infect. 2014;68:321–31.

    Article  PubMed  Google Scholar 

  7. Lee JH, Kim SK, Kim SK, Han SB, Lee JW, Lee DG, et al. Increase in antibiotic-resistant gram-negative bacterial infections in febrile neutropenic children. Infect Chemother. 2016;48:181–9.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  8. Shay DK, Maloney SA, Montecalvo M, Banerjee S, Wormser GP, Arduino MJ, et al. Epidemiology and mortality risk of vancomycin-resistant enterococcal bloodstream infections. J Infect Dis. 1995;172:993–1000.

    Article  CAS  PubMed  Google Scholar 

  9. Theilacker C, Jonas D, Huebner J, Bertz H, Kern WV. Outcomes of invasive infection due to vancomycin-resistant Enterococcus faecium during a recent outbreak. Infection. 2009;37:540–3.

    Article  CAS  PubMed  Google Scholar 

  10. Edmond MB, Ober JF, Weinbaum DL, Pfaller MA, Hwang T, Sanford MD, et al. Vancomycin-resistant Enterococcus faecium bacteremia: risk factors for infection. Clin Infect Dis. 1995;20:1126–33.

    Article  CAS  PubMed  Google Scholar 

  11. Singh-Naz N, Sleemi A, Pikis A, Patel KM, Campos JM. Vancomycin-resistant Enterococcus faecium colonization in children. J Clin Microbiol. 1999;37:413–6.

    CAS  PubMed  PubMed Central  Google Scholar 

  12. Tornieporth NG, Roberts RB, John J, Hafner A, Riley LW. Risk factors associated with vancomycin-resistant Enterococcus faecium infection or colonization in 145 matched case patients and control patients. Clin Infect Dis. 1996;23:767–72.

    Article  CAS  PubMed  Google Scholar 

  13. Lucas GM, Lechtzin N, Puryear DW, Yau LL, Flexner CW, Moore RD. Vancomycin-resistant and vancomycin-susceptible enterococcal bacteremia: comparison of clinical features and outcomes. Clin Infect Dis. 1998;26:1127–33.

    Article  CAS  PubMed  Google Scholar 

  14. Peel T, Cheng AC, Spelman T, Huysmans M, Spelman D. Differing risk factors for vancomycin-resistant and vancomycin-sensitive enterococcal bacteraemia. Clin Microbiol Infect. 2012;18:388–94.

    Article  CAS  PubMed  Google Scholar 

  15. Lautenbach E, Bilker WB, Brennan PJ. Enterococcal bacteremia: risk factors for vancomycin resistance and predictors of mortality. Infect Control Hosp Epidemiol. 1999;20:318–23.

    Article  CAS  PubMed  Google Scholar 

  16. Prematunge C, MacDougall C, Johnstone J, Adomako K, Lam F, Robertson J, et al. VRE and VSE bacteremia outcomes in the era of effective VRE Therapy: a systematic review and meta-analysis. Infect Control Hosp Epidemiol. 2016;37:26–35.

    Article  PubMed  Google Scholar 

  17. Vergis EN, Hayden MK, Chow JW, Snydman DR, Zervos MJ, Linden PK, et al. Determinants of vancomycin resistance and mortality rates in enterococcal bacteremia. a prospective multicenter study. Ann Intern Med. 2001;135:484–92.

    Article  CAS  PubMed  Google Scholar 

  18. Bhavnani SM, Drake JA, Forrest A, Deinhart JA, Jones RN, Biedenbach DJ, et al. A nationwide, multicenter, case-control study comparing risk factors, treatment, and outcome for vancomycin-resistant and -susceptible enterococcal bacteremia. Diagn Microbiol Infect Dis. 2000;36:145–58.

    Article  CAS  PubMed  Google Scholar 

  19. DiazGranados CA, Jernigan JA. Impact of vancomycin resistance on mortality among patients with neutropenia and enterococcal bloodstream infection. J Infect Dis. 2005;191:588–95.

    Article  CAS  PubMed  Google Scholar 

  20. Cho SY, Lee DG, Choi SM, Kwon JC, Kim SH, Choi JK, et al. Impact of vancomycin resistance on mortality in neutropenic patients with enterococcal bloodstream infection: a retrospective study. BMC Infect Dis. 2013;13:504.

    Article  PubMed  PubMed Central  Google Scholar 

  21. Todeschini G, Tecchio C, Borghero C, D’Emilio A, Pegoraro E, de Lalla F, et al. Association between Enterococcus bacteraemia and death in neutropenic patients with haematological malignancies. J Infect. 2006;53:266–73.

    Article  PubMed  Google Scholar 

  22. Han SH, Chin BS, Lee HS, Jeong SJ, Choi HK, Kim CO, et al. Vancomycin-resistant enterococci bacteremia: risk factors for mortality and influence of antimicrobial therapy on clinical outcome. J Infect. 2009;58:182–90.

    Article  PubMed  Google Scholar 

  23. Kosack A, Riedel E, Kiehn TE, Small TN, Wexler LH, Dunkel IJ. Vancomycin-resistant enterococcus in pediatric oncology patients: an analysis of potential consequences of colonization and infection. Pediatr Blood Cancer. 2009;52:300–2.

    Article  PubMed  Google Scholar 

  24. Tamma PD, Hsu AJ. Optimizing therapy for vancomycin-resistant enterococcal bacteremia in children. Curr Opin Infect Dis. 2014;27:517–27.

    Article  CAS  PubMed  Google Scholar 

  25. Lee DG, Kim SH, Kim SY, Kim CJ, Park WB, Song YG, et al. Evidence-based guidelines for empirical therapy of neutropenic fever in Korea. Korean J Intern Med. 2011;26:220–52.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  26. Turner D, Cheifetz I. Shock. In: Kliegman RM, Stanton BF, St. Geme JW, Schor NF, editors. Nelson textbook of pediatrics. 20th edn. Philadelphia: Elsevier; 2016. pp. 516–28.

    Google Scholar 

  27. Sreedharan R, Avner E. Renal failure. In: Kliegman RM, Stanton BF, St. Geme JW, Schor NF, editors. Nelson textbook of pediatrics. 20th edn. Philadelphia: Elsevier; 2016. pp. 2539–47.

    Google Scholar 

  28. Suchy F. Fulminant hepatic failure. In: Kliegman RM, Stanton BF, St. Geme JW, Schor NF, editors. Nelson textbook of pediatrics. 20th edn. Philadelphia: Elsevier; 2016. pp. 1966–8

    Google Scholar 

  29. Satwani P, Freedman JL, Chaudhury S, Jin Z, Levinson A, Foca MD, et al. A multicenter study of bacterial blood stream infections in pediatric allogeneic hematopoietic cell transplantation recipients: the role of acute gastrointestinal graft-versus-host disease. Biol Blood Marrow Transplant. 2017;23:642–7.

    Article  PubMed  Google Scholar 

  30. Almyroudis NG, Osawa R, Samonis G, Wetzler M, Wang ES, McCarthy PL, et al. Discontinuation of systematic surveillance and contact precautions for vancomycin-resistant Enterococcus (VRE) and its impact on the incidence of VRE faecium bacteremia in patients with hematologic malignancies. Infect Control Hosp Epidemiol. 2016;37:398–403.

    Article  PubMed  Google Scholar 

  31. Erlandson KM, Sun J, Iwen PC, Rupp ME. Impact of the more-potent antibiotics quinupristin-dalfopristin and linezolid on outcome measure of patients with vancomycin-resistant Enterococcus bacteremia. Clin Infect Dis. 2008;46:30–6.

    Article  PubMed  Google Scholar 

  32. McKinnell JA, Patel M, Shirley RM, Kunz DF, Moser SA, Baddley JW. Observational study of the epidemiology and outcomes of vancomycin-resistant Enterococcus bacteraemia treated with newer antimicrobial agents. Epidemiol Infect. 2011;139:1342–50.

    Article  CAS  PubMed  Google Scholar 

  33. Kamboj M, Chung D, Seo SK, Pamer EG, Sepkowitz KA, Jakubowski AA, et al. The changing epidemiology of vancomycin-resistant Enterococcus (VRE) bacteremia in allogeneic hematopoietic stem cell transplant (HSCT) recipients. Biol Blood Marrow Transpl. 2010;16:1576–81.

    Article  Google Scholar 

  34. Vydra J, Shanley RM, George I, Ustun C, Smith AR, Weisdorf DJ, et al. Enterococcal bacteremia is associated with increased risk of mortality in recipients of allogeneic hematopoietic stem cell transplantation. Clin Infect Dis. 2012;55:764–70.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  35. Noskin GA, Peterson LR, Warren JR. Enterococcus faecium and Enterococcus faecalis bacteremia: acquisition and outcome. Clin Infect Dis. 1995;20:296–301.

    Article  CAS  PubMed  Google Scholar 

  36. Hayakawa K, Marchaim D, Martin ET, Tiwari N, Yousuf A, Sunkara B, et al. Comparison of the clinical characteristics and outcomes associated with vancomycin-resistant Enterococcus faecalis and vancomycin-resistant E. faecium bacteremia. Antimicrob Agents Chemother. 2012;56:2452–8.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

Download references

Acknowledgements

This study was approved by the Institutional Review Board of Seoul St. Mary’s Hospital, under a waiver of the requirement for obtaining informed consent (Approval number: KC18RESI0231).

Author information

Authors and Affiliations

  1. Department of Pediatrics, College of Medicine, Seoul St. Mary’s Hospital, The Catholic University of Korea, 222 Banpo-daero, Seocho-gu, Seoul, 06591, Republic of Korea

    Kil-Seong Bae, Ju Ae Shin, Seong koo Kim, Seung Beom Han, Jae Wook Lee, Nack-Gyun Chung, Bin Cho, Dae Chul Jeong & Jin Han Kang

  2. The Vaccine Bio Research Institute, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea

    Kil-Seong Bae, Seung Beom Han, Dong-Gun Lee, Dae Chul Jeong & Jin Han Kang

  3. The Catholic Hematology Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea

    Seong koo Kim, Jae Wook Lee, Dong-Gun Lee, Nack-Gyun Chung & Bin Cho

  4. Division of Infectious Diseases, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea

    Dong-Gun Lee

Authors
  1. Kil-Seong Bae
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Ju Ae Shin
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Seong koo Kim
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Seung Beom Han
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Jae Wook Lee
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Dong-Gun Lee
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Nack-Gyun Chung
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Bin Cho
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Dae Chul Jeong
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Jin Han Kang
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Seung Beom Han.

Ethics declarations

Conflict of interest

There is no conflict of interest for all authors.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Bae, KS., Shin, J.A., Kim, S.k. et al. Enterococcal bacteremia in febrile neutropenic children and adolescents with underlying malignancies, and clinical impact of vancomycin resistance. Infection 47, 417–424 (2019). https://doi.org/10.1007/s15010-018-1260-z

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s15010-018-1260-z

Keywords

Search

Navigation