Vancomycin-resistant Enterococcus faecium infection in three children given allogeneic hematopoietic stem cell transplantation: Clinical and microbiological features

E. Carretto, D. Barbarini, F. Locatelli, E. Giraldi, N. Pellegrini, L. Perversi, P. Grossi, P. Marone, F. Bonetti

Research output: Contribution to journalArticle

14 Citations (Scopus)

Abstract

Background and Objectives. The emergence of vancomycin-resistant enterococci (VRE) as nosocomial pathogens is a major problem in the US; in Europe, VRE nosocomial infections are uncommon and only rarely have been reported in Pediatric or Neonatal Units. The aim of this study is to report on the clinical and microbiological features of VRE infections in 3 children given hematopoietic stem cell transplantation (HSCT). Patients and methods. Five episodes of vancomycin-resistant Enterococcus faecium (VREF) infection were diagnosed in 3 children given an allogeneic HSCT. Molecular methods, such as random amplification of polymorphic DNA (RAPD) fingerprinting and automated ribotyping, were used in order to define the circulation of strains. Results. All the isolates were resistant to all commercially available agents and showed the VanA genotypic profile. All children were successfully treated with the combination of quinupristin/dalfopristin (QD) plus teicoplanin (TEC), although treatment was not sufficient to eradicate the micro-organism promptly from the gastrointestinal tract. All our children are still alive. After the first isolation of VRE, a surveillance protocol was started and we documented that the rate of colonization in children and their mother was less than 1.5%. The RAPD method demonstrated the possible nosocomial transmission of one strain. Interpretation and Conclusions. Our experience demonstrates that VRE infection is a life-threatening complication in children given HSCT. Prompt diagnosis of this infection and its treatment with the combination of QD and TEC and successfully manage this severe infection in profoundly immunocompromised patients. (C) 2000, Ferrata Storti Foundation.

Original languageEnglish
Pages (from-to)1158-1164
Number of pages7
JournalHaematologica
Volume85
Issue number11
Publication statusPublished - 2000

Fingerprint

Enterococcus faecium
Hematopoietic Stem Cell Transplantation
Infection
Teicoplanin
Ribotyping
DNA Fingerprinting
Immunocompromised Host
Cross Infection
Gastrointestinal Tract
Vancomycin-Resistant Enterococci
Mothers
Pediatrics
DNA
Therapeutics

Keywords

  • Automated ribotyping
  • Bone marrow transplantation
  • Quinupristin/dalfopristin
  • RAPD
  • Teicoplanin
  • Vancomycin-resistant enterococci

ASJC Scopus subject areas

  • Hematology

Cite this

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title = "Vancomycin-resistant Enterococcus faecium infection in three children given allogeneic hematopoietic stem cell transplantation: Clinical and microbiological features",
abstract = "Background and Objectives. The emergence of vancomycin-resistant enterococci (VRE) as nosocomial pathogens is a major problem in the US; in Europe, VRE nosocomial infections are uncommon and only rarely have been reported in Pediatric or Neonatal Units. The aim of this study is to report on the clinical and microbiological features of VRE infections in 3 children given hematopoietic stem cell transplantation (HSCT). Patients and methods. Five episodes of vancomycin-resistant Enterococcus faecium (VREF) infection were diagnosed in 3 children given an allogeneic HSCT. Molecular methods, such as random amplification of polymorphic DNA (RAPD) fingerprinting and automated ribotyping, were used in order to define the circulation of strains. Results. All the isolates were resistant to all commercially available agents and showed the VanA genotypic profile. All children were successfully treated with the combination of quinupristin/dalfopristin (QD) plus teicoplanin (TEC), although treatment was not sufficient to eradicate the micro-organism promptly from the gastrointestinal tract. All our children are still alive. After the first isolation of VRE, a surveillance protocol was started and we documented that the rate of colonization in children and their mother was less than 1.5{\%}. The RAPD method demonstrated the possible nosocomial transmission of one strain. Interpretation and Conclusions. Our experience demonstrates that VRE infection is a life-threatening complication in children given HSCT. Prompt diagnosis of this infection and its treatment with the combination of QD and TEC and successfully manage this severe infection in profoundly immunocompromised patients. (C) 2000, Ferrata Storti Foundation.",
keywords = "Automated ribotyping, Bone marrow transplantation, Quinupristin/dalfopristin, RAPD, Teicoplanin, Vancomycin-resistant enterococci",
author = "E. Carretto and D. Barbarini and F. Locatelli and E. Giraldi and N. Pellegrini and L. Perversi and P. Grossi and P. Marone and F. Bonetti",
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T1 - Vancomycin-resistant Enterococcus faecium infection in three children given allogeneic hematopoietic stem cell transplantation

T2 - Clinical and microbiological features

AU - Carretto, E.

AU - Barbarini, D.

AU - Locatelli, F.

AU - Giraldi, E.

AU - Pellegrini, N.

AU - Perversi, L.

AU - Grossi, P.

AU - Marone, P.

AU - Bonetti, F.

PY - 2000

Y1 - 2000

N2 - Background and Objectives. The emergence of vancomycin-resistant enterococci (VRE) as nosocomial pathogens is a major problem in the US; in Europe, VRE nosocomial infections are uncommon and only rarely have been reported in Pediatric or Neonatal Units. The aim of this study is to report on the clinical and microbiological features of VRE infections in 3 children given hematopoietic stem cell transplantation (HSCT). Patients and methods. Five episodes of vancomycin-resistant Enterococcus faecium (VREF) infection were diagnosed in 3 children given an allogeneic HSCT. Molecular methods, such as random amplification of polymorphic DNA (RAPD) fingerprinting and automated ribotyping, were used in order to define the circulation of strains. Results. All the isolates were resistant to all commercially available agents and showed the VanA genotypic profile. All children were successfully treated with the combination of quinupristin/dalfopristin (QD) plus teicoplanin (TEC), although treatment was not sufficient to eradicate the micro-organism promptly from the gastrointestinal tract. All our children are still alive. After the first isolation of VRE, a surveillance protocol was started and we documented that the rate of colonization in children and their mother was less than 1.5%. The RAPD method demonstrated the possible nosocomial transmission of one strain. Interpretation and Conclusions. Our experience demonstrates that VRE infection is a life-threatening complication in children given HSCT. Prompt diagnosis of this infection and its treatment with the combination of QD and TEC and successfully manage this severe infection in profoundly immunocompromised patients. (C) 2000, Ferrata Storti Foundation.

AB - Background and Objectives. The emergence of vancomycin-resistant enterococci (VRE) as nosocomial pathogens is a major problem in the US; in Europe, VRE nosocomial infections are uncommon and only rarely have been reported in Pediatric or Neonatal Units. The aim of this study is to report on the clinical and microbiological features of VRE infections in 3 children given hematopoietic stem cell transplantation (HSCT). Patients and methods. Five episodes of vancomycin-resistant Enterococcus faecium (VREF) infection were diagnosed in 3 children given an allogeneic HSCT. Molecular methods, such as random amplification of polymorphic DNA (RAPD) fingerprinting and automated ribotyping, were used in order to define the circulation of strains. Results. All the isolates were resistant to all commercially available agents and showed the VanA genotypic profile. All children were successfully treated with the combination of quinupristin/dalfopristin (QD) plus teicoplanin (TEC), although treatment was not sufficient to eradicate the micro-organism promptly from the gastrointestinal tract. All our children are still alive. After the first isolation of VRE, a surveillance protocol was started and we documented that the rate of colonization in children and their mother was less than 1.5%. The RAPD method demonstrated the possible nosocomial transmission of one strain. Interpretation and Conclusions. Our experience demonstrates that VRE infection is a life-threatening complication in children given HSCT. Prompt diagnosis of this infection and its treatment with the combination of QD and TEC and successfully manage this severe infection in profoundly immunocompromised patients. (C) 2000, Ferrata Storti Foundation.

KW - Automated ribotyping

KW - Bone marrow transplantation

KW - Quinupristin/dalfopristin

KW - RAPD

KW - Teicoplanin

KW - Vancomycin-resistant enterococci

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