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Enterococcal bacteremia in children: Clinical Significance of vancomycin resistance
Kyo Jin Jo1, Hyeon Seo Lee2, Narae Lee1
1Department of Pediatrics, Pusan National University Yangsan Hospital, Pusan National University School of Medicine, Yangsan, Republic of Korea.
Insights
Enterococcal bacteremia in children is often hospital-acquired and linked to underlying conditions. Vancomycin resistance did not significantly impact outcomes in this pediatric study.
Area of Science:
- Pediatric Infectious Diseases
- Clinical Microbiology
- Antimicrobial Resistance
Background:
- Enterococcal bacteremia is a significant concern in pediatric healthcare settings.
- Understanding its clinical and microbiological features is crucial for effective management.
Purpose of the Study:
- To characterize enterococcal bacteremia in Korean children.
- To evaluate the impact of vancomycin resistance on clinical outcomes.
Main Methods:
- Retrospective review of medical records from December 2009 to November 2021.
- Inclusion of pediatric patients with enterococci isolated from blood cultures.
- Analysis of clinical data, microbiological characteristics, and treatment outcomes.
Main Results:
- 64 pediatric patients were included; Enterococcus faecalis was the most common strain.
- Most cases were hospital-acquired (84.4%) in children with underlying diseases (93.8%).
- Ampicillin resistance was 45.3%, and vancomycin resistance was 25%; VRE cases had more frequent bacteremia focus.
Conclusions:
- Pediatric enterococcal bacteremia is typically nosocomial and associated with severe underlying conditions.
- The study suggests that underlying disease may be a more significant prognostic factor than vancomycin resistance.
- Larger, specific cohort studies are needed to confirm these findings.
Background:
We aimed to describe the clinical and microbiological characteristics of enterococcal bacteremia, as well as the effect of Enterococcus resistance against vancomycin on clinical outcomes in Korean children.
Methods:
We retrospectively reviewed the medical records of children diagnosed with enterococci isolated from blood cultures at Pusan National University Children's Hospital between December 2009 and November 2021.
Results:
In total, 64 patients were enrolled in the study. The median age was 0 years (range 0-15), and 43 (67.2%) patients were male. Enterococcus faecalis (50%) was the most commonly identified bacterial strain. Significant underlying diseases were present in 60 patients (93.8%), and the source of bacteremia was identified in 36 patients (56.3%). Among these, intravascular device was the most common identifiable source. Fifty-six (87.5%) patients had previously received broad-spectrum antibiotics and 54 (84.4%) patients were nosocomial in origin. Twenty-nine (45.3%) strains were resistant to ampicillin, and 16 (25%) strains were resistant to vancomycin. All patients with vancomycin-resistant enterococci (VRE) had underlying disease (P = 0.199), and focus of bacteremia was significantly more frequent in VRE patients (P = 0.014). Of all the patients, after appropriate antibiotic treatment, five (7.8%) patients had recurrent enterococcal bacteremia, and seven (10.9%) patients were diagnosed with bacteremia, defined as other pathogens from blood culture. The 30-day mortality rate was 7.8%.
Conclusion:
Enterococcal bacteremia in children is usually nosocomial and occurs in children with serious underlying diseases. Because the number of enrolled patients and mortality were small in our study, it is difficult to identify whether the factor that determines prognosis in patients with enterococcal bacteremia is VRE or an underlying disease. Further studies with a large number of patients in a specific group are needed.
