Enterococcal bacteremia in a pediatric institution: a four-year review

We identified 77 cases of enterococcal bacteremia in 76 children hospitalized at a tertiary care pediatric institution from 1985 to 1989. To define the clinical characteristics of children with enterococcal bacteremia and to assess the bacteriologic features of the infecting isolates, we retrospectively reviewed the charts and reanalyzed the bacteriologic data for 50 cases. Eighty-two percent of cases of bacteremia were nosocomial, and 26% were polymicrobial. Ninety-two percent of patients had significant underlying medical problems and/or had undergone recent surgery. Associated sites of infection included endovascular sites (two cases), the skin (two), and the urinary tract (one). Forty-eight percent of the patients had received antibiotics within 7 days preceding enterococcal bacteremia. Crude mortality figures for patients receiving appropriate two-drug therapy, appropriate monotherapy, and either no therapy or inappropriate therapy were 7%, 20%, and 6.25%, respectively. Children with enterococcal bacteremia constitute a heterogeneous group, although the great majority of cases are acquired in the hospital by children with serious underlying disease. Studies delineating appropriate antibiotic treatment for varied situations are needed.