Pediatric Enterococcal Infection Follow-up

Updated: Jul 27, 2021
  • Author: Meera Varman, MD; Chief Editor: Russell W Steele, MD  more...
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  • 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 in mortality of 3% at 4 weeks of hospitalization compared with standard care. [19]