Paediatric Enterococcal Bacteremia: An Exploration of the Clinical Impact With Emphasis on Antibiotic Resistance

Enterococci can cause serious infections in children, such as bloodstream infections. The aim of this study was to analyse the antibiotic resistance patterns of enterococci, identify associated risk factors, guide appropriate treatment strategies and evaluate the impact on clinical outcomes.

This retrospective observational study was conducted at a tertiary-level university hospital in Türkiye and included patients under 18 years of age who were diagnosed with enterococcal bacteremia between January 2013 and May 2023. All positive Enterococcus spp. blood cultures were evaluated, and contaminated and clinically insignificant blood cultures were excluded. Analyses and comparisons were made of ampicillin and vancomycin resistance profiles, clinical outcomes of healthcare-associated infection (HAI) and community-acquired infection (CAI) and antimicrobial resistance trends were documented throughout the study period.

In a total of 98 enterococcal bloodstream infections, E. faecium was the most common species (40.8%), and the resistance rates to ampicillin and vancomycin among all enterococci were 52% and 12.2%, respectively. In the multivariate model, the odds ratio of ampicillin resistance was higher in those with non-neonatal infection [odds ratio (OR): 6.098; 95% confidence interval (CI): 1.034-35.958; p = 0.046], prior antibiotic use (OR: 5.013; 95% CI: 1.497-16.787; p = 0.009), persistent bacteremia (OR: 8.204; 95% CI: 1.028-65.475; p = 0.047) and inappropriate initial treatment (OR: 11.252; 95% CI: 3.288-38.504; p < 0.001). The study findings indicated that antibiotic resistance did not impact clinical outcomes; although the number of vancomycin-resistant enterococci (VRE) cases was low, no mortality was observed among these patients at our hospital.

Antibiotic resistance in enterococci is common in children with underlying diseases and HAIs. The early empirical glycopeptide therapy consideration for high-risk patients is supported by the prevalence of ampicillin resistance. These findings underline the importance of continuous local surveillance to guide appropriate empiric antibiotic selection and highlight the need for further research into long-term resistance trends and paediatric-specific treatment strategies.