Outbreak of Vancomycin-ResistantEnterococcusColonization Among Pediatric Oncology Patients

Abstract

Objective.To detect the burden of vancomycin-resistantEnterococcus(VRE) colonization among pediatric oncology patients and to determine risk factors for VRE acquisition.Design.Retrospective case-control study.Setting.The Children's Hospital of Philadelphia.Patients.Pediatric oncology patients hospitalized from June 2006 through December 2007.Methods.Prevalence surveys revealed an increased VRE burden among pediatric oncology patients. For the case-control study, the 16 case patients were pediatric oncology patients who had 1 stool sample negative for VRE at screening before having a stool sample positive for VRE at screening; the 62 control patients had 2 consecutive screenings in which stool samples were negative for VRE. Case and control patients were matched on the duration of the interval between screens. Analyses were performed to determine the association between multiple exposures and VRE acquisition.Results.The prevalence survey revealed that 5 (9.6%) of 52 patients had unsuspected VRE colonization at the time of hospitalization. Multivariate analysis identified a lack of empirical contact precautions (odds ratio [OR], 17.16 [95% confidence interval {CI}, 1.49–198.21];P= .02) and the presence of a gastrointestinal device (OR, 4.03 [95% CI, 1.04–15.56];P= .04) as significant risk factors for acquisition of VRE. Observations in the interventional radiology department revealed that staff could not access the portions of the electronic medical record in which isolation precautions were documented. Simple interventions that granted access and that trained interventional radiology staff to review the need for precautions, coupled with enhanced infection control practices, interrupted ongoing transmission and reduced the proportion of VRE screens that were positive to 15 (1.2%) of 1,270.Conclusions.Inadequate communication with regard to infection control precautions can increase the risk of transmission of epidemiologically important organisms, particularly when patients receive care at multiple clinic locations. Adherence to infection control practices across the spectrum of care may limit the spread of resistant organisms.