title: Epidemiology of vancomycin-resistant enterococci in children with acute lymphoblastic leukemia at two referral centers in Tehran, Iran: a descriptive study.
abstract: BACKGROUND
  Risk factors for colonization with vancomycin-resistant enterococci (VRE) vary by population and locale. The objective of this study was to determine the prevalence of and risk factors for VRE colonization in children with acute lymphoblastic leukemia (ALL) in Tehran.
  
  
  METHODS
  Stools were collected from children with ALL at the Ali Asghar Children's Hospital and the Mahak Pediatric Oncology Center between March 2007 and October 2008. Demographic features and potential risk factors for VRE colonization, including duration of ALL, presence of severe neutropenia in the preceding month, receipt of antibiotics in the preceding 3 months, concurrent medical problems, days of hospitalization, and the need for intensive care since the time of diagnosis of ALL, were recorded.
  
  
  RESULTS
  VRE was identified from stools in 33 of 130 children with ALL (25%). No clear risk factors were identified for VRE colonization in the current study, but there was a trend towards an increased prevalence in children admitted to the intensive care unit since their ALL diagnosis (p=0.07). The VanA genotype was found in 28 of the 33 stools (85%), with all other enterococci being VanB.
  
  
  CONCLUSIONS
  The prevalence of VRE colonization in children with ALL in Tehran is high. Modifiable risk factors have not been identified. The implementation of routine surveillance for colonization and an increased emphasis on adherence to standard infection control precautions may prevent spread.
authors.affiliation: Tehran University of Medical Sciences, Ali Asghar Children's Hospital, Tehran, Iran.
authors.forename: A
authors.initials: A
authors.lastname: Nateghian
authors.forename: J L
authors.initials: JL
authors.lastname: Robinson
authors.forename: K
authors.initials: K
authors.lastname: Arjmandi
authors.forename: P
authors.initials: P
authors.lastname: Vosough
authors.forename: A
authors.initials: A
authors.lastname: Karimi
authors.forename: A
authors.initials: A
authors.lastname: Behzad
authors.forename: M
authors.initials: M
authors.lastname: Navidnia
mesh_terms: D000293:Adolescent; D001426:Bacterial Proteins / Q000235:genetics; D019729:Carbon-Oxygen Ligases / Q000235:genetics; D002648:Child; D002675:Child, Preschool; D003428:Cross Infection / Q000453:epidemiology / Q000382:microbiology; D004269:DNA, Bacterial / Q000302:isolation & purification; D016983:Enterococcus / Q000187:drug effects / Q000235:genetics / Q000302:isolation & purification*; D005243:Feces / Q000382:microbiology; D005260:Female; D016908:Gram-Positive Bacterial Infections / Q000175:diagnosis / Q000453:epidemiology* / Q000382:microbiology; D006801:Humans; D007223:Infant; D017053:Infection Control / Q000592:standards; D007362:Intensive Care Units; D007492:Iran / Q000453:epidemiology; D008297:Male; D008826:Microbial Sensitivity Tests; D016133:Polymerase Chain Reaction; D054198:Precursor Cell Lymphoblastic Leukemia-Lymphoma / Q000150:complications*; D015995:Prevalence; D012307:Risk Factors; D020713:Vancomycin Resistance
chemical_list: D001426:Bacterial Proteins; D004269:DNA, Bacterial; C071437:VanA ligase, Bacteria; C079913:VanB protein, Enterococcus; D019729:Carbon-Oxygen Ligases