Neonatal sepsis due to glycopeptide resistant Enterococcus faecium from colonized maternal gut- rare case evidence

Abstract

BackgroundVancomycin-resistant enterococcal infections in the neonatal ICU are growing global problems. We report a case of neonatal septicemia by multidrug-resistant vancomycin-resistant Enterococcus faecium (VRE), the source of infection being the mother’s gut.Case presentationA newborn male child admitted to the neonatal intensive care unit (NICU) was diagnosed to have mild meconium aspiration syndrome, early onset neonatal septicemia, and bacteremia by multidrug and vancomycin-resistant Enterococcus faecium. Screening of gut flora of the baby and the mother were carried out to trace the source of infection. Stool cultures of the mother and the baby yielded Vancomycin-Resistant Enterococcus faecium. All three isolates of Enterococcus faecium had similar antibiogram, harbored the vanA gene and similar pulsed-field gel electrophoresis pattern. Baby responded to the 1 week therapy with oral linezolid suspension 20 mg/kg/day, 1 ml/t.d.s. No VRE was isolated from baby on a repeat stool culture 1 week after the linezolid therapy. He was discharged with the advice for the continuance of linezolid for seven more days.ConclusionIsolation of MDR-VRE from the blood culture of the baby and stool specimens of the mother and the baby with the same antibiogram profile and clonal similarities reveals that maternal gut colonization was responsible for neonatal sepsis. Optimal infection control measures and the development of guidelines for monitoring VRE colonization in pregnant women might be useful in reducing the occurrence of neonatal sepsis.Electronic supplementary materialThe online version of this article (10.1186/s13756-019-0490-x) contains supplementary material, which is available to authorized users.

Gut Microbiota and Metabolome Description of Antibiotic-Treated Neonates From Parturients With Intrauterine Infection

“…Moreover, the relative abundance of Enterococcus was positively correlated with neonate neutrophil and WBC counts, which are indicators of infection and inflammation (Huang et al, 2018). This result supports the association between Enterococcus and neonatal infection, which has been reported in previous studies (Wang et al, 2014;Subramanya et al, 2019).…”

A Proof of Concept of the Role of TDM-Based Clinical Pharmacological Advices in Optimizing Antimicrobial Therapy on Real-Time in Different Paediatric Settings

“…Empirical therapy of early-onset neonatal sepsis is based on the combination of ampicillin plus an aminoglycoside, whereas that of late-onset neonatal sepsis is based on the combination of vancomycin plus an aminoglycoside ( Shane et al, 2017 ). Additionally, linezolid could represent a valuable alternative in neonatal ICUs with high prevalence of vancomycin-resistant Enterococci ( Subramanya et al, 2019 ).…”

“…Empirical therapy of early-onset neonatal sepsis is based on the combination of ampicillin plus an aminoglycoside, whereas that of late-onset neonatal sepsis is based on the combination of vancomycin plus an aminoglycoside (Shane et al, 2017). Additionally, linezolid could represent a valuable alternative in neonatal ICUs with high prevalence of vancomycin-resistant Enterococci (Subramanya et al, 2019). Antimicrobial TDM may be very helpful in this challenging scenario, considering that in the newborns the relationship between drug dose and exposure is quite unpredictable, especially in the pre-terms, due to the abrupt developmental physiological changes that occur in this age period (Pauwels and Allegaert, 2016;De Rose et al, 2020).…”

Rectal vancomycin-resistant enterococcus colonization before admission to neonatal intensive care unit

“…It is known that enterococci is one of the first few bacteria that colonize primarily in the neonatal digestive system via originating from the mother's vaginal or gastrointestinal flora. [14] Subramanya et al [15] reported one early onset septicemia case by vankomisin resistant Enterococcus faecium. They found the same VRE strain from blood samples of the neonate and stool speciemens of the mother at the same time and indicated that maternal gut colonization caused neonatal sepsis.…”