title: Recovery of vancomycin-resistant gram-positive cocci from children.
abstract: A cross-sectional survey of vancomycin-resistant gram-positive cocci (VRGPC) in the feces of children was initiated after several bacteremic infections with these organisms occurred at our hospital. A selective medium consisting of colistin-nalidixic acid agar, 5% sheep blood, vancomycin (5 mg/liter), and amphotericin B (8 mg/liter) was developed to isolate VRGPC. A single stool specimen submitted to the clinical microbiology laboratory from each of 48 patients was inoculated onto the medium. Plates were incubated at 35 degrees C with 5% carbon dioxide and examined at 24, 48, and 72 h. Susceptibilities were determined by broth microdilution. A total of 14 isolates from 11 of 48 (22%) children were recovered. The density of growth ranged from a single colony to 2+. The VRGPC were identified as Leuconostoc lactis (n = 2), Lactobacillus confusus (n = 4), Enterococcus species (n = 5), and Lactococcus lactis (n = 3). One strain of Lactobacillus confusus was recovered from both the stool and the blood of one of these patients. The MICs of vancomycin were 4 micrograms/ml for one of the isolates, 8 micrograms/ml for four of the isolates, and more than 16 micrograms/ml for the remaining eight isolates. All isolates were susceptible to both penicillin and ampicillin. Only 1 of the 11 children had received prior treatment with vancomycin. We conclude that low concentrations of VRGPC may be common in the gastrointestinal tracts of children.
authors.affiliation: Department of Pediatrics, Children's Hospital of Pittsburgh, University of Pittsburgh School of Medicine, Pennsylvania.
authors.forename: M
authors.initials: M
authors.lastname: Green
authors.forename: R M
authors.initials: RM
authors.lastname: Wadowsky
authors.forename: K
authors.initials: K
authors.lastname: Barbadora
mesh_terms: D002648:Child; D003430:Cross-Sectional Studies; D003470:Culture Media; D003967:Diarrhea / Q000382:microbiology; D004352:Drug Resistance, Microbial; D013293:Enterococcus faecalis / Q000187:drug effects / Q000302:isolation & purification; D005243:Feces / Q000382:microbiology; D006094:Gram-Positive Bacteria / Q000187:drug effects* / Q000302:isolation & purification; D006801:Humans; D007778:Lactobacillus / Q000187:drug effects / Q000302:isolation & purification; D007934:Leuconostoc / Q000187:drug effects / Q000302:isolation & purification; D018805:Sepsis / Q000382:microbiology*; D013291:Streptococcus / Q000187:drug effects / Q000302:isolation & purification; D014640:Vancomycin / Q000494:pharmacology*
chemical_list: D003470:Culture Media; D014640:Vancomycin