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Neonatal enterococcal bacteremia: an increasingly frequent event with potentially untreatable pathogens
D F McNeeley1, F Saint-Louis, G J Noel
1New York Hospital-Cornell Medical Center, New York 10021, USA.
Insights
Enterococcal bacteremia in newborns increased significantly over 20 years, often linked to catheters and necrotizing enterocolitis. Vancomycin-resistant strains emerged, causing similar illness patterns in neonatal intensive care units.
Area of Science:
- Neonatal Medicine
- Infectious Diseases
- Microbiology
Background:
- Enterococci are a significant cause of serious infections in newborns.
- Increased incidence of enterococcal infections and antimicrobial resistance since the late 1970s necessitated a review of clinical experiences.
- This study focused on enterococcal bacteremia in a neonatal intensive care unit (NICU) over a 20-year period.
Purpose of the Study:
- To define the characteristics of enterococcal bacteremia in newborns over a two-decade period.
- To analyze trends in incidence and clinical presentation of enterococcal infections in a NICU.
- To investigate the emergence and impact of vancomycin-resistant enterococci in neonates.
Main Methods:
- Retrospective review of medical records for newborns with enterococci isolated from blood cultures.
- Analysis of 138 episodes of enterococcal bacteremia between January 1974 and December 1993.
- Comparison of clinical characteristics between the first and second decade of the study period.
Main Results:
- A threefold increase in enterococcal bacteremia episodes was observed in the second decade (104 episodes) compared to the first (34 episodes).
- Episodes in the second decade occurred in older infants, with common associations including central vascular catheters (77%), necrotizing enterocolitis (33%), and abdominal distension (21%).
- Vancomycin-resistant enterococci caused bacteremia in 6 infants, presenting with clinical features indistinguishable from susceptible strains.
Conclusions:
- Enterococcal bacteremia in the NICU significantly increased over the 20-year study period.
- Clinical features of these nosocomial infections remained consistent, often occurring in polymicrobial settings in prolonged-stay neonates.
- Vancomycin-resistant enterococcal infections in neonates were clinically similar to those caused by susceptible strains, highlighting the need for vigilant monitoring.
Background:
Enterococci can cause serious infections in the newborn. The increased number of these infections since the late 1970s and the increased isolation of organisms resistant to many commonly used antimicrobials prompted review of our experience with enterococcal bacteremia in the neonatal intensive care unit. This review was aimed at defining the character of illness of newborns who had these infections during a 20-year period.
Methods:
This was a retrospective review of the medical records of newborns with enterococci isolated from blood.
Results:
Between January, 1974, and December, 1993, 138 episodes of enterococcal bacteremia occurred in newborns hospitalized in the neonatal intensive care unit. Thirty-four episodes occurred during the first decade and 104 episodes during the second decade. One hundred of the 138 episodes were reviewed. In 64% of these episodes other microorganisms were also isolated from blood. Comparison of clinical characteristics associated with these episodes in the first and second decade demonstrated that episodes occurring in the more recent decade occurred in older infants (mean age of onset, 44.7 vs. 16.1 days; episodes occurring after 14 days, 73% vs. 41%). Common characteristics associated with enterococcal bacteremia included the presence of a central vascular catheter (77%), necrotizing enterocolitis (33%) and abdominal distension (21%). Vancomycin-resistant enterococci caused bacteremia in 6 infants and caused illnesses indistinguishable from those caused by susceptible organisms.
Conclusions:
In the more recent decade there were three times the number of episodes of enterococcal bacteremia in our neonatal intensive care unit than there were in the previous decade. The characteristics associated with these infections were similar to those occurring with other nosocomial bacterial infections in the neonate and did not change during the period reviewed. Most recent episodes occurred as part of polymicrobial infections in newborns hospitalized for more than 1 month. Infections caused by vancomycin-resistant enterococci occurred in older patients but were clinically indistinguishable from infections caused by sensitive organisms.