RESULTS
Of 84 total BSI episodes during the study period, 19 (22.6%) were due to VGS (Table 1). Amongst patients with VGS-BSI, median age was 6.7 (interquartile range (IQR) 2.3-10.7) years and 63.2% (12/19) of episodes occurred in females. The majority (57.9%, 11/19) of VGS-BSI episodes occurred in high-risk patients; 7 with AML, 3 post-HSCT, and in one child with ALL and clinical evidence of shock.
Of the VGS isolates, 21.1% (4/19) were penicillin-resistant, and 36.8% (7/19) had reduced penicillin susceptibility. The median blood culture time-to-positivity was 11.7 (IQR 9.1 - 13.8) hours; 100% flagged positive within 17 hours (Fig. 1). VGS isolates were susceptible to recommended risk-stratified empiric antibiotics in 100% (11/11) of isolates from high-risk patients and 78.9% (15/19) of all episodes. In all non-high-risk, clinically stable patients with a penicillin-resistant VGS isolate (4/19), vancomycin was commenced once the blood culture flagged positive, within 24 hours of fever onset.
All VGS-BSI episodes were associated with fever, and 89.5% (17/19) of patients had neutropaenia. One patient developed intracranial haemorrhage secondary to a leukaemia-related coagulopathy and died in ICU shortly after, unrelated to the VGS-BSI. All other patients recovered without requiring ICU admission; there were no VGS-BSI related deaths. No patients with VGS-BSI had vancomycin associated nephrotoxicity.