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Neonatal enterococcal sepsis: case-control study and description of an outbreak
L M Luginbuhl1, H A Rotbart, R R Facklam
1Department of Pediatrics, University of Colorado School of Medicine, Denver 80262.
Insights
Group D streptococci (GDE) caused a significant increase in neonatal sepsis during an outbreak. This study identified risk factors and confirmed GDE as a key nosocomial pathogen in late-onset neonatal infections.
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.
Abstract:
An increased incidence of neonatal sepsis caused by Group D streptococci, specifically enterococci (GDE), during a recent 6-month period prompted a 5-year review of enterococcal sepsis in our neonatal intensive care unit. Sixteen episodes occurred in 14 babies. GDE accounted for 8 of 19 (42%) episodes of neonatal bacteremia during the epidemic period vs. only 8 of 159 (5%) episodes during the remaining 4.5 years (endemic period) (P less than 0.001). Blood isolates were all identified as Streptococcus faecalis. A combination of three strain-typing methods successfully distinguished the epidemic organisms from endemic nursery strains of GDE and from "background" GDE flora in the hospital. Nursery isolates were all susceptible to ampicillin, intermediate or resistant to the aminoglycosides and variably resistant to the newer cephalosporins. There were no differences in antibiotic susceptibilities of the GDE or in characteristics of the patients that were unique to the epidemic. Neonates with GDE sepsis had a mean birth weight of 913 g, a mean gestational age of 27 weeks and a mean age of onset of sepsis of 8.5 weeks. Twenty-five controls, matched for birth weight and admission date, were identified. Significant differences (P less than 0.05) between cases and controls included: use of a nonumbilical central line (71 vs. 32%); days central line in place (26.5 vs. 6.5 days); and bowel resection (29 vs. 4%). This is the first reported outbreak of S. faecalis sepsis in neonates. GDE are important nosocomial pathogens that must be considered in late onset neonatal sepsis.