Clinical Characteristics and Antimicrobial Resistance Profiles of Pediatric Enterococcal Infections: A Comparison...

Objective: To compare the clinical characteristics, healthcare exposures, and antimicrobial susceptibility profiles of pediatric Enterococcus faecium and Enterococcus faecalis infections. Methods: This retrospective study included hospitalized children with E. faecium or E. faecalis isolated from sterile specimens between August 2018 and June 2025. Clinical characteristics and antimicrobial susceptibility were compared. Logistic regression identified factors associated with pathogen species, while negative binomial regression evaluated the association between species and length of hospital stay. Results: Among 167 patients, 98 had E. faecium infection and 69 had E. faecalis infection. No significant annual trend in species distribution was observed. Multi-site infection was more common with E. faecium than with E. faecalis (36.73% vs. 15.94%, p = 0.003). Hematologic malignancy, previous hospitalization, central venous catheterization, immunosuppressive therapy, higher procalcitonin levels, and longer hospitalization were more common in the E. faecium group. In three separate primary logistic regression models adjusted for septic shock, central venous catheterization and hospitalization for ≥14 days before culture positivity were associated with higher odds of E. faecium infection, whereas endotracheal intubation was associated with higher odds of E. faecalis infection. In post hoc sensitivity analyses jointly incorporating these healthcare exposures and either hematologic malignancy or immunosuppressive therapy, only central venous catheterization remained significantly associated with E. faecium infection. E. faecium infection was associated with a 33.8% longer hospital stay (aIRR = 1.338, 95% CI: 1.160-1.543, p < 0.001). E. faecium showed substantially greater resistance to ampicillin and penicillin. Conclusions: Pediatric E. faecium and E. faecalis infections differed in patient profiles, healthcare exposures, antimicrobial susceptibility, and disease burden. Species identification may support clinical assessment and antimicrobial stewardship.