Enterococcal colonization of infants in a neonatal intensive care unit: associated predictors, risk factors and seasonal patterns

Abstract

BackgroundDuring and shortly after birth, newborn infants are colonized with enterococci. This study analyzes predictors for early enterococcal colonization of infants in a neonatal intensive care unit and describes risk factors associated with multidrugresistant enterococci colonization and its seasonal patterns.MethodsOver a 12-month period, we performed a prospective epidemiological study in 274 infants admitted to a neonatal intensive care unit. On the first day of life, we compared infants with enterococcal isolates detected in meconium or body cultures to those without. We then tested the association of enterococcal colonization with peripartal predictors/risk factors by using bivariate and multivariate statistical methods.ResultsTwenty-three percent of the infants were colonized with enterococci. The three most common enterococcal species were E. faecium (48% of isolates), E. casseliflavus (25%) and E. faecalis (13%). Fifty-seven percent of the enterococci found were resistant to three of five antibiotic classes, but no vancomycin-resistant isolates were observed. During winter/spring months, the number of enterococci and multidrug-resistant enterococci were higher than in summer/fall months (p = 0.002 and p < 0.0001, respectively). With respect to enterococcal colonization on the first day of life, predictors were prematurity (p = 0.043) and low birth weight (p = 0.011). With respect to colonization with multidrug-resistant enterococci, risk factors were prematurity (p = 0.0006), low birth weight (p < 0.0001) and prepartal antibiotic treatment (p = 0.019). Using logistic regression, we determined that gestational age was the only parameter significantly correlated with multidrug-resistant enterococci colonization. No infection with enterococci or multidrugresistant enterococci in the infants was detected. The outcome of infants with and without enterococcal colonization was the same with respect to death, necrotizing enterocolitis, intracerebral hemorrhage and bronchopulmonary dysplasia.ConclusionIn neonatal intensive care units, an infant's susceptibility to early colonization with enterococci in general, and his or her risk for colonization with multidrug-resistant enterococci in particular, is increased in preterm newborns, especially during the winter/spring months. The prepartal use of antibiotics with no known activity against enterococci appears to increase the risk for colonization with multidrug-resistant enterococci.

Impact of empiric antibiotic regimen on bowel colonization in neonates with suspected early onset sepsis

“…However, which antibiotic should be preferred in this respect is more controversial. Similarly to Hufnagel et al we demonstrate that early mucosal colonization is associated neither with increased risk of enterococcal bacteraemia nor with increase in overall mortality [38]. More interestingly, recent in vitro data indicate that some strains of E. faecalis could suppress the proliferation of intestinal pathogens and thus have a potential to prevent infection and induction of inflammation suggesting that enterococcal colonization may even be beneficial.…”

The Threat of Aerobic Vaginitis to Pregnancy and Neonatal Morbidity

“…Resistance to trimethoprim, gentamycin and vancomycin have also been reported 79,80 . An association was found between increased enterococcal colonization and prematurity 73 , with preterm birth neonates who carry E. faecalis being more likely to be suffering from NEC than neonates born at term 24,25 . The presence of E. faecalis in the amniotic fluid considerably increases the risk of histological inflammation of the placenta (OR 10.7, 95% CI 1.27-89.9) and also increases the risk for bronchopulmonary dysplasia (BPD) and NEC 81 .…”

“…The enterococcal species which are considered to be significant pathogens for humans are E. faecalis and E. faecium. These organisms are likely to affect patients who are elderly or whose normal microbiota has been altered by antibiotic treatment 73 . Furthermore, in neonates, E. faecalis is associated with 6% mortality rate in early onset septicaemia (EOS) which increases to 15% in late-onset (LOS) infections, whilst in general it is implicated in 7% to 50% of fatal cases 74 .…”

“…Group D enterococci and non-enterococci are part of the genital tract, but are a common cause of urinary tract infections, subacute bacterial endocarditis, abdominal abscesses, and wound infections 73,74 . The predominance of asymptomatic genital tract infection in pregnant women has been reported in the literature 75 , with enterococci causing life threatening infections in preterm infants and other immuno-compromised patients 73 . The enterococcal species which are considered to be significant pathogens for humans are E. faecalis and E. faecium.…”

Risk factors for vancomycin-resistant enteroccocci colonization in infants in neonatal intensive care unit

“…In our clinic, during this period VRE colonization rate among infants were 24%. Although reports concerning VRE colonization in NICU were rare, one study from Turkey reported that 8 of 110 neonates who were screened for VRE, was found to be colonized with VRE (7,2%) [6] and another study from Germany reported VRE colonization as 13,1% [20].…”