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Lee, Kim, and Kim: Influence Factors for Duration of Vancomycin Resistant Enterococci's Spontaneous Decolonization
Orginal Article

Pediatr Infect Vaccine 2015;22(1):16-22.

Published online: 21 January 2015

DOI: https://doi.org/10.14776/piv.2015.22.1.16

Influence Factors for Duration of Vancomycin Resistant Enterococci's Spontaneous Decolonization

Jae Sun Lee, M.D., Dong Soo Kim, M.D., Ki Hwan Kim, M.D.

Department of Pediatrics, Severance Children's Hospital, Yonsei University College of Medicine, Seoul, Korea

Received 18 September 201425 October 2014       Accepted 28 October 2014

Copyright © 2015 The Korean Society of Pediatric Infectious Diseases

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

The aim of this study was to identify the factors influencing the spontaneous decolonization period of vancomycin resistant enterococcus (VRE) species in pediatric patients. Methods: The medical records of patients presenting positive VRE cultures between January 2005 and November 2010 at a tertiary hospital in Seoul, Korea, were reviewed retrospectively. The subjects were divided into two groups according to the average number of days for decolonization (325 days). Clinical characteristics were compared between shorter VRE colonization patients (<325 days, n=41) and prolonged VRE colonization patients (>325 days, n=110). Results: There were 151 patients who had more than 1 year of follow up period or confirmed of VRE decolonization among patients who were identified with VRE. The average age at the time of initial VRE colonization was significantly younger in shorter decolonization group than in prolonged decolonization group (44.9 months vs 40.9 months, P:0.040). The prolonged decolonization group received more vancomycin treatments after VRE colonization in comparison with patients in shorter decolonization group (7.0% vs 27.2%, P:0.008). Conclusions: For the duration of VRE colonization, it was found that the initial age of acquiring VRE and use of antibiotics were important factors. Antibiotics should be used properly and precisely in order to treat infectious diseases and to control the colonization of antibiotic resistant bacteria.

Keywords: Key Words, Vancomycin Resistant Enterococcus, Children, Spontaneous decolonization

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Fig. 1.
Flow sheet of patients enrolled in this study.
piv-22-16f1.tif
Table 1.
Comparison of Baseline Demographic and Clinical Characteristics with Shorter Vancomycin Resistant Enterococcus Colonization Group and Prolonged Vancomycin Resistant Enterococcus Colonization Group
  Total, n=151 Shorter qroup, n=41 Prolonqed group, n=110 Pvalue
Male 70 (46.1) 19 (46.5) 51 (45.9) 0573∗
Age at colonization (months) 42.0±513 44.9±523 40.9±51.1 0.040T
Underlying disease
  Hemato-oncologic 51 (33.8) 14 (34.1) 36 (32.7) N/A‘
  Neurologic 22 (14.6) 9 (20.9) 1302.6) N/A
  Suraical 54 (36.7) 11 (22.0) 43 (39.1) N/A
  Other 16(10.6) 3 (7.3) 13(118) N/A
  No underlyning disease 9 (6.0) 4 (9.8) 5 (4.5) N/A
VREJ positive specimen
  Urine 97 (64.2) 25 (61.0) 72 (65.5) N/A
  Stool 42 (27.8) 1381.7) 29 (26.4) N/A
  Blood 4 (2.6) 1 (2.4) 3 (2.7) N/A
  Other 9 (6.0) 2 (4.9) 7 (6.4) N/A
Duration of hospitalization day before colonization (days) 26.0:±45.7 22.7±35.0 27.3±493 0.5861
Duration of hospitalization day after colonization (davs) 45.4±151.1 61.6±2343 39.3±104.5 0.422T
ICU” stay at colonization 65 (43.0) 15 (36.6) 50 (45.5) 0214∗
Duration of ICU stay before colonization (days) 31.8±57.8 22.7±22.8 35.01435] 0.483T
Duration of ICU stay after colonization (davs) 49.5±1369 21.4±26.6 55.4:1498 0.529T
Total ICU stay duration (days) 49.3±1503 32.0±40.0 53.5±166.7 0.610T
Medical device 85 (56.5) 23 (55.8) 62 (56.8) 0560∗
  Central line 68 (45.5) 18 (44.2) 50 (45.9) O.810∗
  Enteral tube feeding 20 (14.3) 3 (7.0) 17(17.1) 0341∗
  Intubation 29 (17.5) 10 (23.3) 19 (15.3) 0248∗
Immunosuppressive aqents 47 (31.8) 16 (39.5) 31 (28.8) 0.140∗

Values represent the number of subjects (%) or mean±SD. ∗P values were obtained by x2 test. TP values were obtained by student's t—test. tnot applicable. ‘I‘Vancomycin resistant enz‘erococcus. Intensive casre unit

Table 2.
Comparison of Antibiotic Use before Vancomycin Resistant Enterococcus Colonization between Prolonged Vancomycin Resistant Enterococcus Colonization Group and Shorter Vancomycin Resistant Enterococcus Colonization Group
Shorter group, n:41 (°/n\ Prolonged group, n:110 (°/n\ P I value
Amino-penicillin 16 (39.0) 45 (40.9) 0.223
First-aeneration ceohalosoorins 1 (2.4) 0(0) 0.069
Spmnd-npnorafinn (enhlmnorim 5(12.2) 9(87) 0,707
Third—generation cephalosporins 30 (73.2) 81(74.5) 0.197
Fourth-qeneration cephalosporins 2 (4.7) 17(16.3) 0.053
Aminonlwmides 22 (53.5) 62(59.6) 0,19”)
Piperacillin/tazobactam 4 (9.3) 4 (3.8) 0.094
(arhnnpnpm< 8(18.6) 33{32.7} 0.080
Vancomycin 3 (7.0) 10 (9.6) 0.229
Teicoplanin 13 (30.2) 33 (32.7) 0.254
Mmmnidamlp 11 {7am U(?R m 0.145
Macrolide 5(11.6) 35 (33.7) 0.007
Clindamvcin 2 (4.7) 7 (6.7) 0.232
Trimethoorim/suIfamethoxazole 0 (0) 28 (26.9) 0.000
Quinolone 0 (0) 1(1.0) 0.225
Table 3.
Comparison of Antibiotic Use after Vancomycin Resistant Enterococcus Colonization between Prolonged Vancomycin Resistant Enterococcus Colonization Group and Shorter Vancomycin Resistant Enterococcus Colonization Group
Shorter group, n=41 (%) Prolonged group, n=110 (%) P value
Amino-penicillin 21(51.2) 55 (50.0) 0.894
First-generation cephalosporins 2 (4.9) 6 (5.5) 0.888
Second-generation cephlosporins 14(34.1) 31 (28.2) 0.476
Third-generation cephalosporins 29 (70.7) 88 (80.0) 0.225
F0urth»generation cephalosporins 7(17.1) 41 (37.3) 0.018
aminoglycosides 25 (61.0) 75 (68.2) 0.405
Piperacillin/tazobactam 5(12.2) 7 (6.4) 0.239
:arbapenems 8 (19.6) 56 (50.9) 0.001
Vancomycin 3 (7.3) 30 (27.2) 0.008
Teicoplanin 11 (26.8) 66 (60.0) 0.000
Metronidazole 11 (26.8) 50 (45.5) 0.038
Vlacrolide 1361.7) 58 (52.7) 0.021
Clindamycin 4 (9.8) 14 (12.7) 0.616
Trimethoprim/sulTamethoxazole 0 (0) 37 (33.6) 0.000
Quinolone 0 (0) 2 (1.8) 0.385

D values were obtained by x‘ test.

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