Leuconostoc bacteremia in pediatric patients with short bowel syndrome: case series and review.
BACKGROUND
Infections caused by Leuconostoc species are rare with most reported cases occurring in immunocompromised patients. This article presents 6 new cases of pediatric patients with short bowel syndrome who developed Leuconostoc bacteremia, and compares these cases with those previously reported in the literature.


METHODS
This is a retrospective, descriptive study (January 2001 to May 2007) performed in a tertiary care teaching center. Hospitalized patients younger than 18 years of age, with multiple positive blood cultures for Leuconostoc spp. were evaluated. The collected data were compared with 10 similar previously reported cases.


RESULTS
Six new cases of pediatric patients with short bowel syndrome who developed Leuconostoc bacteremia were identified. All 6 patients had received total parenteral nutrition and had central venous access, while 3 of these patients also received enteral nutrition. These results are similar to those reported in the literature. Only one of the newly reported patients had received vancomycin therapy before detection of Leuconostoc in the blood, whereas all prior reported cases had previously received this antimicrobial agent. Molecular analysis identified Leuconostoc mesenteroides as the most common species (4 cases) detected.


CONCLUSIONS
This report expands on the number of cases of Leuconostoc bacteremia in pediatric patients with short bowel syndrome and shows that prior vancomycin is not a required risk factor for the development of this infection. As previously reported in the literature, the presence of a central venous catheter and disrupted bowel mucosa are risk factors for Leuconostoc bacteremia.
Florescu
Diana
D
Immunocompromised Host Infectious Diseases Program, Microbiology University of Nebraska Medical Center, Omaha, NE, USA. dflorescu@unmc.edu
Hill
Lisa
L
Sudan
Debra
D
Iwen
Peter C
PC
D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D016470:Bacteremia / Q000175:diagnosis / Q000188:drug therapy / Q000209:etiology*; D002408:Catheters, Indwelling / Q000009:adverse effects / Q000382:microbiology; D002648:Child; D002675:Child, Preschool; D004750:Enteral Nutrition; D005260:Female; D005839:Gentamicins / Q000627:therapeutic use; D016908:Gram-Positive Bacterial Infections / Q000175:diagnosis / Q000188:drug therapy / Q000209:etiology*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007934:Leuconostoc / Q000187:drug effects / Q000235:genetics / Q000302:isolation & purification; D008297:Male; D010289:Parenteral Nutrition, Total; D010400:Penicillin G / Q000627:therapeutic use; D016133:Polymerase Chain Reaction; D012189:Retrospective Studies; D012307:Risk Factors; D017422:Sequence Analysis, DNA; D012778:Short Bowel Syndrome / Q000150:complications*; D014640:Vancomycin / Q000627:therapeutic use; D020713:Vancomycin Resistance
D000900:Anti-Bacterial Agents; D005839:Gentamicins; D014640:Vancomycin; D010400:Penicillin G