title: Risk of vancomycin-resistant enterococci bloodstream infection among patients colonized with vancomycin-resistant enterococci.
abstract: BACKGROUND
  Vancomycin-resistant enterococci colonization has been reported to increase the risk of developing infections, including bloodstream infections.
  
  
  OBJECTIVE
  In this study, we aimed to share our experience with the vancomycin-resistant enterococci bloodstream infections following gastrointestinal vancomycin-resistant enterococci colonization in pediatric population during a period of 18 months.
  
  
  METHODS
  A retrospective cohort of children admitted to a 400-bed tertiary teaching hospital in Izmir, Turkey whose vancomycin-resistant enterococci colonization was newly detected during routine surveillances for gastrointestinal vancomycin-resistant enterococci colonization during the period of January 2009 and December 2012 were included in this study. All vancomycin-resistant enterococci isolates found within 18 months after initial detection were evaluated for evidence of infection.
  
  
  RESULTS
  Two hundred and sixteen patients with vancomycin-resistant enterococci were included in the study. Vancomycin-resistant enterococci colonization was detected in 136 patients (62.3%) while they were hospitalized at intensive care units; while the remaining majority (33.0%) were hospitalized at hematology-oncology department. Vancomycin-resistant enterococci bacteremia was present only in three (1.55%) patients. All these patients were immunosuppressed due to human immunodeficiency virus (one patient) and intensive chemotherapy (two patients).
  
  
  CONCLUSIONS
  In conclusion, our study found that 1.55% of vancomycin-resistant enterococci-colonized children had developed vancomycin-resistant enterococci bloodstream infection among the pediatric intensive care unit and hematology/oncology patients; according to our findings, we suggest that immunosupression is the key point for developing vancomycin-resistant enterococci bloodstream infections.
authors.affiliation: Department of Pediatric Infectious Disease, Dr. Behçet Uz Children's Hospital, İzmir, Turkey. Electronic address: ahukara01@hotmail.com.
authors.forename: Ahu
authors.initials: A
authors.lastname: Kara
authors.affiliation: Department of Pediatric Infectious Disease, Dr. Behçet Uz Children's Hospital, İzmir, Turkey.
authors.forename: İlker
authors.initials: İ
authors.lastname: Devrim
authors.affiliation: Department of Pediatric Infectious Disease, Dr. Behçet Uz Children's Hospital, İzmir, Turkey.
authors.forename: Nuri
authors.initials: N
authors.lastname: Bayram
authors.affiliation: Department of Pediatrics, Dr. Behçet Uz Children's Hospital, İzmir, Turkey.
authors.forename: Nagehan
authors.initials: N
authors.lastname: Katipoğlu
authors.affiliation: Department of Pediatrics, Dr. Behçet Uz Children's Hospital, İzmir, Turkey.
authors.forename: Ezgi
authors.initials: E
authors.lastname: Kıran
authors.affiliation: Hospital Infection Control Committee, Dr. Behçet Uz Children's Hospital, İzmir, Turkey.
authors.forename: Yeliz
authors.initials: Y
authors.lastname: Oruç
authors.affiliation: Hospital Infection Control Committee, Dr. Behçet Uz Children's Hospital, İzmir, Turkey.
authors.forename: Nevbahar
authors.initials: N
authors.lastname: Demiray
authors.affiliation: Department of Pediatrics, Dr. Behçet Uz Children's Hospital, İzmir, Turkey.
authors.forename: Hurşit
authors.initials: H
authors.lastname: Apa
authors.affiliation: Department of Clinical Microbiology, Dr. Behçet Uz Children's Hospital, İzmir, Turkey.
authors.forename: Gamze
authors.initials: G
authors.lastname: Gülfidan
mesh_terms: D000293:Adolescent; D016470:Bacteremia / Q000453:epidemiology / Q000276:immunology / Q000382:microbiology*; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D003428:Cross Infection / Q000453:epidemiology / Q000276:immunology / Q000382:microbiology*; D005260:Female; D016908:Gram-Positive Bacterial Infections / Q000453:epidemiology / Q000276:immunology / Q000382:microbiology*; D006801:Humans; D016867:Immunocompromised Host; D007223:Infant; D007231:Infant, Newborn; D015278:Intensive Care Units, Pediatric; D008297:Male; D012189:Retrospective Studies; D012307:Risk Factors; D065507:Vancomycin-Resistant Enterococci
keywords: Bloodstream infections; Colonization; Immunosupression; Vancomycin-resistant enterococcus