Introduction: Data on Enterococcal bacteremia (EB) in immunocompromised children is scarce. We aimed to describe EB in children with hematological malignancies (HM), solid tumors (ST) and/or following allo-HSCT.
Methods: Retrospective analysis in Hadassah Medical center (2001-2014). We collected demographic, clinical, and laboratory data, and compared it in ampicillin- or vancomycin-sensitive and resistant episodes.
Results: 56/1123 HM/ST/HSCT children developed 74 episodes of EB, 62% E.faecium, 36.5% E.faecalis, 1.5% E.gallinarum. EB rates were: 8.5% in HSCT, 5.1% in HM, 6.0% in neuroblastoma and 1.0% in other ST patients. 85.1% were nosocomial episodes; 87.9% occurred in children under high-intensity chemotherapy. Resistance rates: ampicillin, 58%; vancomycin (VRE), 21.6%, fluoroquinolones 77%, higher rates observed among E. faecium. Among VRE, 1/16 was linezolid- and 2/10 daptomycin-resistant. 7-days and 30-days mortality rates were 2.7% and 5.4%, respectively. 30-day mortality was 18.2% in recurrent; and 0% in the first-time EB episodes (p=0.006).
Univariate analysis revealed the following risk factors:
- for ampicillin-resistance: age≤5 years (p=0.028), treatment intensity (p=0.002), malignancy relapse (p=0.044), any (p=0.003) and, specifically, aminoglycosides (p=0.015) previous antibiotic therapy, breakthrough on meropenem (p=0.004).
- for vancomycin-resistance: previous penicillins treatment (p=0.035), breakthrough on vancomycin (p=0.001).
In the multivariate analysis, previous penicillin exposure predisposed to vancomycin-resistance (p-value 0.029, adjusted OR 4.328, 95% CI 1.166-16.068).
Conclusions: EB occurs mainly as a nosocomial infection in children receiving high-intensity chemotherapy, especially those with neuroblastoma, HM and post HSCT. Antibiotic resistance is common; vancomycin-resistance can occur regardless of previous vancomycin use. Prognosis is good; recurrent EB is, however, associated with high mortality.
