Analysis of the clinical characteristics and susceptibility factors for bloodstream infections of Enterococcus faecium in children / 中华实用儿科临床杂志

ABSTRACT

Objective:To explore the clinical characteristics and susceptibility factors for bloodstream infections (BSI) of Enterococcus faecium in children, thus providing guidance for clinical prevention and treatment. Methods:Clinical data of 18 children with BSI of Enterococcus faecium treated in the West China Second University Hospital, Sichuan University from January 2011 to October 2019 were collected.Their underlying diseases, predisposing factors, clinical information, etiological data, treatment and prognosis were retrospectively analyzed. Results:Sixteen of 18 children (88.9%) with BSI of Enterococcus faecium had underlying diseases, including intestinal diseases or intestinal surgery, preterm infants, hematological diseases, congenital heart disease, biliary atresia and urinary system malformations.Seventeen of 18 children (94.4%) had predisposing factors, including broad-spectrum antibiotics exposure, Intensive Care Unit (ICU) admission, central venous catheterization, malnutrition, abdominal distension or intestinal infection, granulopenia or agranulocyte, mechanical ventilation.The underlying diseases and susceptible factors varied with the age of patients.The most common predisposing factors of all-aged patients with BSI of Enterococcus faecium were broad-spectrum antibiotics exposure (76.5%) and central venous catheterization (52.9%). In patients with single infection of Enterococcus faecium, their C-reactive protein (CRP) was normal or slightly elevated and no children died.The incidences of respiratory failure, shock and severe sepsis in patients with single infection of Enterococcus faecium were 16.6%, 0% and 8.3% respectively, which were 33.3%, 33.3% and 66.7% respectively in 6 children (33.3%) with mixed infections, and one died.Vancomycin-resistant strains were not found, and Vancomycin treatment was effective that quickly relieved clinical symptoms. Conclusions:(1)Most of children with BSI of Enterococcus faecium have underlying diseases and susceptible factors.The most common predisposing factors of all-aged patients with BSI of Enterococcus faecium are broad-spectrum antibiotics exposure and central venous catheterization.(2)The pathogenicity of Enterococcus faecium is low, and the clinical manifestations of BSI are atypical.(3)There is a high rate of mixed infections of Enterococcus faecium, and the severity and mortality of the mixed infected children are much higher than those with single infection.(4)No Vancomycin-resistant strains are found, and vancomycin treatment is effective that quickly relieves clinical symptoms.(5)Rational use of antibiotics and strict management of central venous cathete-rization are the most important preventive measures.