Neonatal enterococcal sepsis: case-control study and description of an outbreak

Area of Science:

• Neonatal Medicine
• Infectious Diseases
• Microbiology

Background:

• Neonatal sepsis poses a significant threat to infant health.
• Enterococci, specifically Group D streptococci (GDE), are increasingly recognized as nosocomial pathogens.
• Understanding outbreak patterns and risk factors is crucial for effective prevention and treatment.

Purpose of the Study:

• To investigate a 6-month increase in neonatal sepsis caused by Group D streptococci (GDE).
• To review enterococcal sepsis over a 5-year period in a neonatal intensive care unit.
• To identify risk factors associated with GDE sepsis in neonates.

Main Methods:

• Retrospective review of 16 episodes of enterococcal sepsis in 14 neonates over 5 years.
• Comparison of an epidemic period (6 months) with an endemic period (4.5 years).
• Utilized three strain-typing methods to differentiate GDE strains and compared clinical characteristics and risk factors between cases and controls.

Main Results:

• GDE accounted for 42% of bacteremia during the epidemic vs. 5% during the endemic period (P < 0.001).
• All isolates were Streptococcus faecalis; epidemic strains were distinct from endemic and background strains.
• Significant risk factors for GDE sepsis included nonumbilical central line use (71% vs. 32%), longer central line duration, and prior bowel resection.

Conclusions:

• This is the first reported outbreak of Streptococcus faecalis sepsis in neonates.
• Group D streptococci (GDE) are significant nosocomial pathogens in late-onset neonatal sepsis.
• Risk factors such as central line use and bowel resection are associated with GDE sepsis, necessitating targeted preventive strategies.