Enterococcal Bacteremia in Children:A Review of Fifty Episodes in a Pediatric Hospital

Eun, Byung Wook; Chung, Eun Hee; Kim, Young Gi; Kim, Je Hak; Lee, Hoan Jong

Abstract

BACKGROUND: Episode of Enterococcal bacteremia has increasingly been reported for the past 15 years in USA, but there have been few systematic studies on its occurrence among Korean children. This study was carried out to determine the epidemiologic, clinical and laboratory characteristics of enterococcal bacteremia in Korean children.
METHODS
Fifty episodes of enterococcal bacteremia among Korean children were retrospectively analyzed. Clinical and microbiological data were collected for all episodes of enterococcal bacteremia which occurried during 9-year period between November, 1992, and August, 2001 at the Seoul National University Children's Hospital.
RESULTS
Significant underlying diseases were present in 47 (94%) episodes, including cardiac or abdominal surgery (44%), cardiac disease (30%), and chronic gastrointestinal disorders (16%). Thirty- eight (76%) episodes were nosocomial in origin, and 14 (28%) episodes were polymicrobial bacteremia. The source of bacteremia was identified in 16 (32%) episodes, intravascular device being the most common identifiable source. Of the 47 isolates identified at species level, 20 strains were Enterococcus faecium, 26 Enterococcus faecalis and one Enterococcus avium. Seventy-two percent of E. faecium cases were resistant to ampicillin. 36 cases (80%) had high-level resistance to gentamicin and sixteen cases (36%) to streptomycin. There was no strain resistant to vancomycin. Three clinical patterns were identified; self-limited bacteremia, 20%; low grade sepsis with favorable outcome after specific therapy, 42%; severe and prolonged infection, 30%; and unclassified, 8%. The overall mortality rate was 10.8%.
CONCLUSION
Enterococcal bacteremia in children was usually nosocomial and comprised a heterogeneous group. The majority of cases occurred in children with serious underlying diseases. The frequency of high-level resistance to gentamicin in enterococcal isolates was high.