Pediatric Enterococcal Infection Follow-up

  • Author: Meera Varman, MD; Chief Editor: Russell W Steele, MD   more...
 
Updated: Mar 12, 2012
 

Deterrence/Prevention

  • A unified effort by all physicians is necessary to slow increasing morbidity and mortality rates associated with vancomycin-resistant Enterococcus (VRE). The Hospital Infection Control Advisory Committee has published the following policies to limit the spread of VRE:
    • Routine screening for vancomycin resistance among clinical isolates
    • Contact isolation of colonized or infected persons (ie, gown, gloves, hand washing)
    • Restriction of instruments used in patient care to an infected or colonized patient's room only (including electronic thermometers with probe sheaths)
    • Thorough decontamination of environmental surfaces
    • Vancomycin not recommended for routine surgical prophylaxis, primary treatment of antibiotic-associated colitis, prophylaxis of low birth weight infants, and dialysis prophylaxis
    • Active surveillance for VRE in ICU
  • An epidemiologic surveillance study performed in a large neonatal ICU (NICU) over 3 years has shown that combining routine contact precautions, active screening cultures, and rep-polymerase chain reaction (PCR) aids in the detection and reduction of the clonal spread of VRE. An electronic thermometer was identified as a source in one of the clonal outbreaks. This is also supported by applying a mathematical model using simulators, which suggests that VRE colonization in a 10-bed ICU can be reduced by more than 60% by isolating patients upon admission until the surveillance cultures obtained at admission are negative for VRE.
  • Standard and contact precautions are indicated in children with VRE infection or colonization. These precautions should continue until the patient is no longer receiving antibiotics and culture results from multiple body sites and indwelling urinary catheter or colostomy sites, if present, are negative on at least 3 separate occasions (>1 wk apart).
  • Refer to Endocarditis, Bacterial for further details and recommendations issued by the American Heart Association (AHA) for prevention of bacterial endocarditis.
  • Oral bacitracin had been shown to eradicate enterococci from stool better than vancomycin. However, recurrences have been noted after about 1-3 weeks after completion of treatment.
  • In a large study of 5939 ICU patients, oropharyngeal or digestive decontamination resulted in a reduction of in mortality of 3% at 4 weeks of hospitalization compared with standard care.[16]
 
Contributor Information and Disclosures
Author

Meera Varman, MD  Associate Professor, Department of Pediatrics, Section of Pediatric Infectious Diseases, Creighton University Medical Center

Meera Varman, MD is a member of the following medical societies: American Academy of Pediatrics, Infectious Diseases Society of America, and Pediatric Infectious Diseases Society

Disclosure: phamaceutical companies Honoraria speaker; phamaceutical companies Grant/research funds clinical trials research

Coauthor(s)

Archana Chatterjee, MD, PhD  Professor of Pediatrics, Medical Microbiology and Immunology, and Pharmacy, Division of Pediatric Infectious Diseases, Chief of Division of Pediatric Infectious Diseases, Creighton University School of Medicine; Hospital Epidemiologist and Medical Director of Infection Control, Children's Hospital

Archana Chatterjee, MD, PhD is a member of the following medical societies: American Academy of Pediatrics, American Society for Microbiology, International Society for Infectious Diseases, Pediatric Infectious Diseases Society, and Society for Pediatric Research

Disclosure: Nothing to disclose.

Walid Abuhammour, MD, FAAP  Professor of Pediatrics, Michigan State University College of Medicine; Director of Pediatric Infectious Disease, Department of Pediatrics, Hurley Medical Center

Walid Abuhammour, MD, FAAP is a member of the following medical societies: American Medical Association, Infectious Diseases Society of America, and Pediatric Infectious Diseases Society

Disclosure: Nothing to disclose.

Specialty Editor Board

José Rafael Romero, MD  Director of Pediatric Infectious Diseases Fellowship Program, Associate Professor, Department of Pediatrics, Combined Division of Pediatric Infectious Diseases, Creighton University/University of Nebraska Medical Center

José Rafael Romero, MD is a member of the following medical societies: American Academy of Pediatrics, American Society for Microbiology, Infectious Diseases Society of America, New York Academy of Sciences, and Pediatric Infectious Diseases Society

Disclosure: Nothing to disclose.

Mary L Windle, PharmD  Adjunct Associate Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Nothing to disclose.

Larry I Lutwick, MD  Professor of Medicine, State University of New York Downstate Medical School; Director, Infectious Diseases, Veterans Affairs New York Harbor Health Care System, Brooklyn Campus

Larry I Lutwick, MD is a member of the following medical societies: American College of Physicians and Infectious Diseases Society of America

Disclosure: Nothing to disclose.

Robert W Tolan Jr, MD  Chief, Division of Allergy, Immunology and Infectious Diseases, The Children's Hospital at Saint Peter's University Hospital; Clinical Associate Professor of Pediatrics, Drexel University College of Medicine

Robert W Tolan Jr, MD is a member of the following medical societies: American Academy of Pediatrics, American Medical Association, American Society for Microbiology, American Society of Tropical Medicine and Hygiene, Infectious Diseases Society of America, Pediatric Infectious Diseases Society, Phi Beta Kappa, and Physicians for Social Responsibility

Disclosure: Novartis Honoraria Speaking and teaching

Chief Editor

Russell W Steele, MD  Head, Division of Pediatric Infectious Diseases, Ochsner Children's Health Center; Clinical Professor, Department of Pediatrics, Tulane University School of Medicine

Russell W Steele, MD is a member of the following medical societies: American Academy of Pediatrics, American Association of Immunologists, American Pediatric Society, American Society for Microbiology, Infectious Diseases Society of America, Louisiana State Medical Society, Pediatric Infectious Diseases Society, Society for Pediatric Research, and Southern Medical Association

Disclosure: Nothing to disclose.

Additional Contributors

The authors and editors of eMedicine gratefully acknowledge the contributions of previous author Warren C Johnson III, MD, to the development and writing of this article.

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This photomicrograph reveals cocci-shaped Enterococcus species bacteria taken from a patient with pneumonia.
 
 
 
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