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[Enterococci as pathogens of severe infections in newborn infants and young infants]
E Halle1, E L Grauel, E Günther
1Institut für Medizinische Mikrobiologie, Bereiches Medizin (Charité) der Humboldt-Universität zu Berlin.
Insights
Severe perinatal infections caused by enterococci led to a high mortality rate in infants. Ampicillin-gentamicin combination therapy proved effective against these enterococcal infections.
Area of Science:
- Neonatal infections
- Bacterial pathogenesis
- Antimicrobial resistance
Context:
- A 5-year study (1983-1987) at Charité-Hospital's Neonatology Department investigated severe perinatal enterococcal infections.
- Eight infants were treated, with five fatalities, highlighting the severity of these infections.
- Both early-onset and late-onset enterococcal infections were observed, with early-onset cases mimicking Group B Streptococcus disease.
Purpose:
- To analyze the incidence, clinical presentation, and outcomes of severe perinatal enterococcal infections.
- To identify potential contributing factors to the observed increase in enterococcal infections in 1987.
- To evaluate the efficacy of different antimicrobial therapies for enterococcal infections in neonates.
Summary:
- Five out of eight infants treated for severe perinatal enterococcal infections died during the study period.
- The clinical course of early-onset enterococcal infections was similar to that of Group B Streptococcus infections.
- A potential increase in enterococcal infections in 1987 may be linked to the use of cephalosporin-based antibiotic regimens (cefotiam or cefotaxime combined with gentamicin), potentially selecting for resistant enterococci.
Impact:
- The findings underscore the significant threat of enterococcal infections in neonates.
- The study suggests that current chemotherapy regimens might inadvertently promote the selection of enterococci.
- An ampicillin-gentamicin combination is recommended as an effective treatment for enterococcal infections based on in vitro and clinical data.
Abstract:
We report about severe perinatal infections caused by enterococci during a 5 year-period. Between January 1983 and December 1987 8 infants were treated in the Department of Neonatology of the Charité-Hospital, 5 of them died. In 4 of the infants this infection was of the early onset type and in 4 infants the infection had a late onset. The clinical course of the four infants with early onset type was very similar to that of infants with group-B-streptococcus disease. The increase of severe infections caused by enterococci in 1987 (7 cases) is unclear. One cause of the increase could be, that the chemotherapy of septicemia and meningitis in the Department of Neonatology of the Charité is the combination cefotiam and gentamicin or cefotaxime and gentamicin. Enterococci are resistant to all cephalosporins and a selection of these pathogens after this therapy is possible. In vitro and clinical experience has demonstrated, that a ampicillin-gentamicin combination constitutes effective therapy for enterococcal infection.