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Enterococcal bacteremia in febrile neutropenic children and adolescents with underlying malignancies, and clinical impact of vancomycin resistance

  • Kil-Seong Bae
  • Ju Ae Shin
  • Seong koo Kim
  • Seung Beom HanEmail author
  • Jae Wook Lee
  • Dong-Gun Lee
  • Nack-Gyun Chung
  • Bin Cho
  • Dae Chul Jeong
  • Jin Han Kang
Original Paper



Enterococci are a common cause of bacteremia in immunocompromised patients. Although the increase of vancomycin-resistant enterococci (VRE) makes appropriate antibiotic therapy difficult, clinical characteristics of enterococcal bacteremia and the impact of VRE infection on outcomes have rarely been reported in immunocompromised children.


We enrolled children and adolescents (< 19 years of age) with underlying malignancies who were diagnosed with enterococcal bacteremia during febrile neutropenia between 2010 and 2017. Medical records of the enrolled children were retrospectively reviewed to evaluate the clinical characteristics of enterococcal bacteremia and impact of VRE infection on outcomes.


Thirty-six episodes of enterococcal bacteremia were identified in 30 patients. VRE infection was identified in 11 episodes (30.6%); the 7- and 30-day mortalities were 27.8% and 44.4%, respectively. Acute lymphoblastic leukemia (50.0%) and acute myeloid leukemia (30.6%) were the most common underlying disorders. Three (8.3%) of the patients were in complete remission, and palliative and reinduction chemotherapies were administered in 47.2% and 36.1% of episodes, respectively. Empirical antibiotic therapy was appropriate in 64.0% of patients with vancomycin-susceptible enterococcal infection and in none of the VRE-infected patients (p = 0.001). However, the 30-day mortality was not significantly different between the two patient groups (44.0% vs. 45.5%, p = 1.000).


Most episodes of enterococcal bacteremia occurred in advanced stages of underlying malignancies, and still showed high mortality. The prognosis seemed to be related to the underlying disease condition rather than vancomycin resistance of the isolated enterococci, although the number of enrolled patients was small.


Enterococcus Vancomycin resistance Neutropenia Child 



This study was approved by the Institutional Review Board of Seoul St. Mary’s Hospital, under a waiver of the requirement for obtaining informed consent (Approval number: KC18RESI0231).

Compliance with ethical standards

Conflict of interest

There is no conflict of interest for all authors.


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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  • Kil-Seong Bae
    • 1
    • 2
  • Ju Ae Shin
    • 1
  • Seong koo Kim
    • 1
    • 3
  • Seung Beom Han
    • 1
    • 2
    Email author
  • Jae Wook Lee
    • 1
    • 3
  • Dong-Gun Lee
    • 2
    • 3
    • 4
  • Nack-Gyun Chung
    • 1
    • 3
  • Bin Cho
    • 1
    • 3
  • Dae Chul Jeong
    • 1
    • 2
  • Jin Han Kang
    • 1
    • 2
  1. 1.Department of Pediatrics, College of Medicine, Seoul St. Mary’s HospitalThe Catholic University of KoreaSeoulRepublic of Korea
  2. 2.The Vaccine Bio Research Institute, College of MedicineThe Catholic University of KoreaSeoulRepublic of Korea
  3. 3.The Catholic Hematology Hospital, College of MedicineThe Catholic University of KoreaSeoulRepublic of Korea
  4. 4.Division of Infectious Diseases, Department of Internal Medicine, College of MedicineThe Catholic University of KoreaSeoulRepublic of Korea

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