Enterococcus fecalis Sepsis and Leukemoid Reaction: An Unusual Association at Birth

Enterococcus fecalis is a nosocomial, opportunistic pathogen, known to cause late-onset sepsis in preterm neonates and is notorious for its association with high mortality and resistance to commonly used antibiotics, such as penicillin, ampicillin, aminoglycosides, and vancomycin. Neonatal leukemoid reaction, defined as the white blood cell count ≥50×10/L or absolute neutrophil count >30×10/L, is a poor prognostic factor in chorioamnionitis. Occurrence of neonatal leukemoid reaction in E. fecalis-mediated sepsis is rare. We report development of leukemoid reaction in a preterm, extremely low-birth-weight neonate with early-onset sepsis caused by E. fecalis that was resistant to ampicillin and aminoglycosides.