To the Editor.—
Enterococci are emerging pathogens causing nosocomial infections in both the United States1 and Europe.2 Several studies on the risk factors of enterococcal bacteremia (EB) have been published in recent years,3,4 but only in adults. Data on nosocomial enterococcal infections in children are anecdotal and include meningitis and endocarditis.5,6 Therefore, we separately evaluated all cases of EB at Children’s University Hospital appearing within 3 years (January 1, 1997–January 1, 2000) and compared this data with adult EB. Twenty-four cases of EB in 24 children were compared with 108 adult cases of EB from a national survey. In a univariate analysis (χ2 with Yates correction), gentamicin and cotrimoxazol resistance in enterococci (P < .001), tetracycline resistance (P = .002), vascular catheter insertion (P = .01), ventillatory support (P < .001), corticosteroid therapy (P = .009), previous antibiotic prophylaxis (P < .001), and therapy with cephalosporins (P < .001) were risk factors significantly related to EB in children in comparison to adults. Fortunately, mortality in children was lower than in adults (12.5% vs 40.1%; P = .03; see Table 1). Vancomycin-resistant EB did not appear in children at all (8% in adults). However, this difference was not significant. In critically ill children at high risk for development of EB, in our opinion, the initial antibiotic therapy should contain antimicrobial agents active against enterococci such as piperacillin/tazobactam, or ampicillin/sulbactam or vancomycin or teicoplanin.
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- ↵Bouza E, and the ESGNI Study Group. Prevalence of nosocomial bloodstream infection in Europe. Clin Microbiol.2000;6 :1,2– 36
- ↵Garbutt JM, Vertrapragda M, Litenberg TTB, Mundy L. Association between resistance to vancomycine and death in case of Enterococcus faecium bacteremia. Clin Infect Dis.2000;30 :466– 472
- ↵Edmond MB, Ober JF, Weinbaum DL, Pfaller MA, Hwang T, Sanford MD. Vancomycin resistant Enterococcus faecium bacteremia: risk factors for infection. Clin Infect Dis.1995;20 :1126– 1133
- ↵Kr Abcméry V, Filka J, Krupova I, Mateicka F. Enterococcal meningitis in neonates. J Chemoth.1999;10 :5
- Copyright © 2003 by the American Academy of Pediatrics