title: Rising Vancomycin-Resistant Enterococcus Infections in Hospitalized Children in the United States.
abstract: Vancomycin-resistant Enterococcus (VRE) is an emerging drug-resistant organism responsible for increasing numbers of nosocomial infections in adults. Few data are available on the epidemiology and impact of VRE infections in children. We hypothesized a significant increase in VRE infections among hospitalized children. Additionally, we predicted that VRE infection would be associated with certain comorbid conditions and increased duration and cost of hospitalization.
  
  
  
  A retrospective study of inpatient pediatric patients was performed using data on hospitalizations for VRE from the Healthcare Cost and Utilization Project Kids' Inpatient Database from 1997 to 2012. We used a multivariable logistic regression model to establish factors associated with VRE infection and a high-dimensional propensity score match to evaluate death, length of stay, and cost of hospitalization.
  
  
  
  Hospitalizations for VRE infection showed an increasing trend, from 53 hospitalizations per million in 1997 to 120 in 2012 (P < .001). Conditions associated with VRE included Clostridium difficile infection and other diagnoses involving immunosuppression and significant antibiotic and health care exposure. Patients with VRE infection had a significantly longer length of stay (attributable difference [AD] 2.1 days, P < .001) and higher hospitalization costs (AD $8233, P = .004). VRE infection was not associated with an increased risk of death (odds ratio 1.03; 95% confidence interval 0.73-1.47).
  
  
  
  VRE infections among hospitalized children are increasing at a substantial rate. This study demonstrates the significant impact of VRE on the health of pediatric patients and highlights the importance of strict adherence to existing infection control policies and VRE surveillance in certain high-risk pediatric populations.
authors.affiliation: Department of Pediatrics, F. Edward Hebert School of Medicine, Uniformed Services University of the Health Sciences, Bethesda, Maryland; and daniel.adams@usuhs.edu.
authors.forename: Daniel J
authors.initials: DJ
authors.lastname: Adams
authors.affiliation: Department of Pediatrics, F. Edward Hebert School of Medicine, Uniformed Services University of the Health Sciences, Bethesda, Maryland; and.
authors.forename: Matthew D
authors.initials: MD
authors.lastname: Eberly
authors.affiliation: Department of Pediatrics, University of Arkansas for Medical Sciences, Little Rock, Arkansas.
authors.forename: Anthony
authors.initials: A
authors.lastname: Goudie
authors.affiliation: Department of Pediatrics, F. Edward Hebert School of Medicine, Uniformed Services University of the Health Sciences, Bethesda, Maryland; and.
authors.forename: Cade M
authors.initials: CM
authors.lastname: Nylund
mesh_terms: D002648:Child; D002675:Child, Preschool; D015897:Comorbidity; D003428:Cross Infection / Q000188:drug therapy / Q000453:epidemiology; D016208:Databases, Factual; D016983:Enterococcus; D005260:Female; D016908:Gram-Positive Bacterial Infections / Q000188:drug therapy* / Q000453:epidemiology*; D006760:Hospitalization / Q000191:economics; D006801:Humans; D016867:Immunocompromised Host; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D015999:Multivariate Analysis; D012189:Retrospective Studies; D014481:United States / Q000453:epidemiology; D020713:Vancomycin Resistance