title: Outbreak of vancomycin-resistant enterococcus colonization among pediatric oncology patients.
abstract: OBJECTIVE
  To detect the burden of vancomycin-resistant Enterococcus (VRE) colonization among pediatric oncology patients and to determine risk factors for VRE acquisition.
  
  
  METHODS
  Retrospective case-control study.
  
  
  METHODS
  The Children's Hospital of Philadelphia.
  
  
  METHODS
  Pediatric oncology patients hospitalized from June 2006 through December 2007.
  
  
  METHODS
  Prevalence surveys revealed an increased VRE burden among pediatric oncology patients. For the case-control study, the 16 case patients were pediatric oncology patients who had 1 stool sample negative for VRE at screening before having a stool sample positive for VRE at screening; the 62 control patients had 2 consecutive screenings in which stool samples were negative for VRE. Case and control patients were matched on the duration of the interval between screens. Analyses were performed to determine the association between multiple exposures and VRE acquisition.
  
  
  RESULTS
  The prevalence survey revealed that 5 (9.6%) of 52 patients had unsuspected VRE colonization at the time of hospitalization. Multivariate analysis identified a lack of empirical contact precautions (odds ratio [OR], 17.16 [95% confidence interval {CI}, 1.49-198.21]; P= .02) and the presence of a gastrointestinal device (OR, 4.03 [95% CI, 1.04-15.56]; P= .04) as significant risk factors for acquisition of VRE. Observations in the interventional radiology department revealed that staff could not access the portions of the electronic medical record in which isolation precautions were documented. Simple interventions that granted access and that trained interventional radiology staff to review the need for precautions, coupled with enhanced infection control practices, interrupted ongoing transmission and reduced the proportion of VRE screens that were positive to 15 (1.2%) of 1,270.
  
  
  CONCLUSIONS
  Inadequate communication with regard to infection control precautions can increase the risk of transmission of epidemiologically important organisms, particularly when patients receive care at multiple clinic locations. Adherence to infection control practices across the spectrum of care may limit the spread of resistant organisms.
authors.affiliation: Division of Infectious Diseases, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania 19104, USA. nolans@email.chop.edu
authors.forename: Sheila M
authors.initials: SM
authors.lastname: Nolan
authors.forename: Jeffrey S
authors.initials: JS
authors.lastname: Gerber
authors.forename: Theoklis
authors.initials: T
authors.lastname: Zaoutis
authors.forename: Priya
authors.initials: P
authors.lastname: Prasad
authors.forename: Susan
authors.initials: S
authors.lastname: Rettig
authors.forename: Kimberly
authors.initials: K
authors.lastname: Gross
authors.forename: Karin L
authors.initials: KL
authors.lastname: McGowan
authors.forename: Anne F
authors.initials: AF
authors.lastname: Reilly
authors.forename: Susan E
authors.initials: SE
authors.lastname: Coffin
mesh_terms: D000293:Adolescent; D000900:Anti-Bacterial Agents / Q000494:pharmacology; D016022:Case-Control Studies; D002648:Child; D002675:Child, Preschool; D003428:Cross Infection / Q000453:epidemiology* / Q000382:microbiology / Q000517:prevention & control / Q000635:transmission; D004196:Disease Outbreaks; D016983:Enterococcus / Q000145:classification / Q000187:drug effects* / Q000302:isolation & purification; D005260:Female; D016908:Gram-Positive Bacterial Infections / Q000453:epidemiology* / Q000382:microbiology / Q000517:prevention & control / Q000635:transmission; D006776:Hospitals, Pediatric / Q000706:statistics & numerical data*; D006801:Humans; D017053:Infection Control / Q000379:methods; D008297:Male; D016522:Oncology Service, Hospital / Q000706:statistics & numerical data*; D015143:Philadelphia; D015995:Prevalence; D012307:Risk Factors; D014640:Vancomycin / Q000494:pharmacology; D020713:Vancomycin Resistance
chemical_list: D000900:Anti-Bacterial Agents; D014640:Vancomycin