[Vancomycin-resistant enterococci in pediatric hematology: don't panic!].
Do immunocompromised children, carrying vancomycin-resistant enterococci (VRE) need to be treated? For 3 years, 230 children with chemotherapy and/or bone-marrow transplantation (BMT) received amikacin for gut decontamination and rinsed their mouth with solutions including vancomycin or not, according to the duration and severity of neutropenia. Some patients were isolated, others were at home with ambulatory treatment. The first-line antibio-therapy was piperacillin-amikacin-vancomycin in the chemotherapy unit, imipenem-vancomycin in the BMT unit. Once-a-week, the laboratory used to check the efficiency of decontamination procedures and look for emerging resistant bacteria. Four patients were identified as VRE carriers in their gut flora. The fecal carriage was long-lasting in a single patient, for whom attempts of eradication failed. No patient underwent VRE bacteremia. From our experience, it seems reasonable to neglect enterococcal eradication, provided that hygienic measures are strictly applied.
Laboratoire de Bactériologie, Faculté de Pharmacie (UPRES-EA 1655), Hôpital Debrousse, Lyon, France.
G
G
Barbé
C
C
Ploton
C
C
Pondarré
Y
Y
Bertrand
G
G
Souillet
N
N
Philippe
D000583:Amikacin / Q000627:therapeutic use; D000741:Anemia, Aplastic / Q000150:complications / Q000628:therapy; D000970:Antineoplastic Agents / Q000627:therapeutic use; D016026:Bone Marrow Transplantation; D002353:Carrier State; D002405:Catheterization, Central Venous / Q000009:adverse effects; D002648:Child; D003666:Decontamination; D004352:Drug Resistance, Microbial; D004359:Drug Therapy, Combination / Q000627:therapeutic use; D016983:Enterococcus / Q000187:drug effects* / Q000302:isolation & purification; D004866:Equipment Contamination; D005243:Feces / Q000382:microbiology; D005602:France / Q000453:epidemiology; D016908:Gram-Positive Bacterial Infections / Q000453:epidemiology / Q000382:microbiology*; D019337:Hematologic Neoplasms / Q000150:complications / Q000628:therapy; D006701:Home Nursing; D006760:Hospitalization; D006801:Humans; D006920:Hygiene; D015378:Imipenem / Q000627:therapeutic use; D016867:Immunocompromised Host; D009055:Mouth / Q000382:microbiology; D009067:Mouthwashes / Q000008:administration & dosage; D010878:Piperacillin / Q000627:therapeutic use; D011292:Premedication; D011446:Prospective Studies; D019172:Transplantation Conditioning / Q000009:adverse effects; D014640:Vancomycin / Q000008:administration & dosage / Q000494:pharmacology* / Q000627:therapeutic use
D000970:Antineoplastic Agents; D009067:Mouthwashes; D014640:Vancomycin; D015378:Imipenem; D000583:Amikacin; D010878:Piperacillin
Entérocoques résistants á la vancomycine en hématologie pédiatrique: pas de panique!