NEONATAL ENTEROCOCCAL BACTEREMIA - AN INCREASINGLY FREQUENT EVENT WITH POTENTIALLY UNTREATABLE PATHOGENS

Background, Enterococci can cause serious infections in the newborn, T he increased number of these infections since the late 1970s and the i ncreased isolation of organisms resistant to many commonly used antimi crobials prompted review of our experience with enterococcal bacteremi a in the neonatal intensive care unit. This review was aimed at defini ng the character of illness of newborns mho had these infections durin g a 20-year period. Methods. This was a retrospective review of the me dical records of newborns with enterococci isolated from blood, Result s. Between January, 1974, and December, 1993, 138 episodes of enteroco ccal bacteremia occurred in newborns hospitalized in the neonatal inte nsive care unit, Thirty-four episodes occurred during the first decade and 104 episodes during the second decade. One hundred of the 138 epi sodes were reviewed. In 64% of these episodes other microorganisms wer e also isolated from blood. Comparison of clinical characteristics ass ociated with these episodes in the first and second decade demonstrate d that episodes occurring in the more recent decade occurred in older infants (mean age of onset, 44.7 vs. 16.1 days; episodes occurring aft er 14 days, 73% vs. 41%). Common characteristics associated with enter ococcal bacteremia included the presence of a central vascular cathete r (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 o rganisms. Conclusions. In the more recent decade there were three time s the number of episodes of enterococcal bacteremia in our neonatal in tensive care unit than there were in the previous decade. The characte ristics associated with these infections were similar to those occurri ng with other nosocomial bacterial infections in the neonate and did n ot change during the period reviewed. Most recent episodes occurred as part of polymicrobial infections in newborns hospitalized for more th an 1 month. Infections caused by vancomycin-resistant enterococci occu rred in older patients but were clinically indistinguishable from infe ctions caused by sensitive organisms.