Bacteremia in a pediatric hemodialysis unit secondary toEnterococcus fecalis

Bacteremia is often a serious and recurring problem in children with hemodialysis catheters. We report an outbreak ofEnterococcus bacteremia in a pediatirc hemodialysis unit occurring from June 1992 to June 1993. During this period, 18 episodes of bacteremia occurred in eight children: 11 infections were polymicrobial.Enterococcus fecalis was associated with 13 infections in five patients (8 polymicrobial). Other pathogens includedEnterobacter cloacae (5 infections),Staphylococcus (3),Staphylococcus epidermidis (2), andKlebsiella pneumoniae (2). AllEnterococcus infections occurred in patients with dual-lumen subclavian venous catheters. Skin and catheter sites were culture negative, except in one patient. Rectal swabs were positive forEnterococcus in five patients.Enterococcus was not isolated from any source within the unit. Serotypes of allEnterococcus isolates were different, except for 2 isolates in the same patient. Starting in June 1993, catheters were flushed after dialysis with vancomycin or ampicillin. Since initiating this procedure, further episodes ofEnterococcus bacteremia have not occurred. A questionnaire sent to other pediatric hemodialysis units failed to identifyEnterococcus among 26 cases of bacteremia. In conclusion: (1)Enterococcus is an unusual pathogen for hemodialysis-related bacteremia in children; (2) patients with dialysis catheters were predisposed to this infection; (3) a common source forEnterococcus could not be identified by either culture or by serotyping; (4) flushing catheters with antibiotics after dialysis was effective prevention.