title: Impact of vancomycin-resistant enterococci colonization in critically ill pediatric patients.
abstract: We aimed to determine the frequency of vancomycin-resistant enterococci (VRE) infection occurrence in previously VRE-colonized children in a pediatric intensive care unit (PICU) and to identify associated risk factors.
  
  
  
  Infection control nurses have performed prospective surveillance of health care-associated infections and rectal VRE carriage in PICUs from January 2010-December 2014. This database was reviewed to obtain information about VRE-colonized and subsequently infected patients. A case-control study was performed to identify risk factors associated with VRE infection development in previously VRE-colonized patients.
  
  
  
  Out of 1,134 patients admitted to the PICU, 108 (9.5%) were found to be colonized with VRE throughout the study period. Systemic VRE infections developed in 11 VRE-colonized patients (10.2%), and these included primary bloodstream infection (n = 6), urinary tract infection (n = 3), meningitis and bloodstream infection (n = 1), and meningitis (n = 1). Logistic regression analysis indicated long hospital stay (≥30 days) and glycopeptide use after detection of VRE colonization as risk factors for developing VRE infection in VRE-colonized patients (odds ratio [OR], 5.76; 95% confidence interval [CI], 1.6-15.8; P = .017 and OR, 12.8; 95% CI, 1.9-26.6; P = .012, respectively).
  
  
  
  VRE colonization has important consequences in pediatric critically ill patients. Strict infection control measures should be implemented to prevent VRE colonization and thereby VRE infections. Furthermore, irrational antibiotic use and particularly glycopeptide use in VRE-colonized patients should be restricted.
authors.affiliation: Department of Pediatric Infectious Diseases, Istanbul Medical Faculty, Istanbul University, Istanbul, Turkey.
authors.forename: Murat
authors.initials: M
authors.lastname: Sutcu
authors.affiliation: Department of Pediatric Infectious Diseases, Istanbul Medical Faculty, Istanbul University, Istanbul, Turkey. Electronic address: hacergunakturk@gmail.com.
authors.forename: Hacer
authors.initials: H
authors.lastname: Akturk
authors.affiliation: Department of Pediatric Infectious Diseases, Istanbul Medical Faculty, Istanbul University, Istanbul, Turkey.
authors.forename: Manolya
authors.initials: M
authors.lastname: Acar
authors.affiliation: Department of Pediatric Infectious Diseases, Istanbul Medical Faculty, Istanbul University, Istanbul, Turkey.
authors.forename: Nuran
authors.initials: N
authors.lastname: Salman
authors.affiliation: Department of Clinical Microbiology, Istanbul Medical Faculty, Istanbul University, Istanbul, Turkey.
authors.forename: Derya
authors.initials: D
authors.lastname: Aydın
authors.affiliation: Department of Clinical Microbiology, Istanbul Medical Faculty, Istanbul University, Istanbul, Turkey.
authors.forename: Bahar
authors.initials: B
authors.lastname: Akgun Karapınar
authors.affiliation: Hospital Infection Control Committee, Istanbul Medical Faculty, Istanbul University, Istanbul, Turkey.
authors.forename: Aslı
authors.initials: A
authors.lastname: Ozdemir
authors.affiliation: Hospital Infection Control Committee, Istanbul Medical Faculty, Istanbul University, Istanbul, Turkey.
authors.forename: Rukiye
authors.initials: R
authors.lastname: Cihan
authors.affiliation: Department of Pediatric Intensive Care, Istanbul Medical Faculty, Istanbul University, Istanbul, Turkey.
authors.forename: Agop
authors.initials: A
authors.lastname: Citak
authors.affiliation: Department of Pediatric Infectious Diseases, Istanbul Medical Faculty, Istanbul University, Istanbul, Turkey.
authors.forename: Ayper
authors.initials: A
authors.lastname: Somer
mesh_terms: D016470:Bacteremia / Q000453:epidemiology / Q000382:microbiology; D002353:Carrier State / Q000453:epidemiology* / Q000382:microbiology*; D016022:Case-Control Studies; D002675:Child, Preschool; D016638:Critical Illness; D062665:Epidemiological Monitoring; D005260:Female; D016908:Gram-Positive Bacterial Infections / Q000453:epidemiology* / Q000382:microbiology*; D006801:Humans; D007223:Infant; D015278:Intensive Care Units, Pediatric; D008297:Male; D016920:Meningitis, Bacterial / Q000453:epidemiology / Q000382:microbiology; D012189:Retrospective Studies; D012307:Risk Factors; D014552:Urinary Tract Infections / Q000453:epidemiology / Q000382:microbiology; D065507:Vancomycin-Resistant Enterococci / Q000302:isolation & purification*
keywords: Vancomycin-resistant enterococci; colonization; infection; pediatric intensive care unit