Demirci Büşra, Gülhan Belgin, Yücel Sevinç Püren, Gürel Fehmiye Funda Karkın, Hakbilen Bengü, Gölge Büşra Elif Şahin, Kanık-Yüksek Saliha, Erat Tuğba, Yahşi Aysun, Özen Seval, Kurtipek Fatma Burçin, Bayhan Gülsüm İclal, Özkaya-Parlakay Aslınur
Department of Pediatrics, Ankara Bilkent City Hospital, Ankara, Turkey.
Department of Pediatric Infectious Diseases, University of Health Sciences, Ankara Bilkent City Hospital, Ankara, Turkey.
Eur J Clin Microbiol Infect Dis. 2025 Sep 18. doi: 10.1007/s10096-025-05263-w.
Enterococcal bloodstream infections (EBIs) are increasingly concerning in pediatric patients due to high morbidity, mortality, and antimicrobial resistance, especially vancomycin-resistant enterococci (VRE). This study aimed to evaluate clinical characteristics, species distribution, risk factors, and outcomes of pediatric EBSIs, focusing on VRE and mortality predictors.
This retrospective study analyzed 368 children with confirmed enterococcal bacteremia. Demographic, clinical, microbiological, and treatment data were collected. Comparative analyses were done between species, VRE vs. vancomycin-susceptible enterococci (VSE), and mortality outcomes. Logistic regression identified independent risk factors for VRE and mortality.
Mean age was 5.2 ± 3.8 years, with 53.8% male. Common underlying conditions included hematologic/oncologic malignancies (20.9%), necrotizing enterocolitis (18.8%), and neurological disorders (16.8%). E. faecalis (51.9%) and E. faecium (41.6%) were the most frequent isolates, with VRE detected in 10.9%, predominantly among E. faecium isolates. Older age, prior VRE colonization, E. faecium infection, total parenteral nutrition (TPN) use, and persistent bacteremia significantly increased the risk of VRE infection. The overall 30-day mortality rate was 9.0%, while the total mortality during follow-up reached 20.7%. Thirty-day mortality was independently predicted by prior carbapenem use (OR = 3.2), whereas overall mortality was significantly associated with receipt of TPN (OR = 1.9), ICU admission (OR = 6.5), persistent bacteremia (OR = 3.6), and prior vancomycin use (OR = 2.2).
Pediatric EBSIs are linked with significant comorbidities and mortality. VRE presence, persistent infection, and prior broad-spectrum antibiotic use increase mortality risk, highlighting the need for antimicrobial stewardship and risk-based management.
由于发病率、死亡率高以及存在抗菌药物耐药性，尤其是耐万古霉素肠球菌（VRE），肠球菌血流感染（EBI）在儿科患者中日益受到关注。本研究旨在评估儿科EBSI的临床特征、菌种分布、危险因素及转归，重点关注VRE和死亡率预测因素。
这项回顾性研究分析了368例确诊为肠球菌血症的儿童。收集了人口统计学、临床、微生物学及治疗数据。对不同菌种、VRE与万古霉素敏感肠球菌（VSE）以及死亡率转归进行了比较分析。逻辑回归确定了VRE和死亡率的独立危险因素。
平均年龄为5.2±3.8岁，男性占53.8%。常见的基础疾病包括血液学/肿瘤学恶性肿瘤（20.9%）、坏死性小肠结肠炎（18.8%）和神经系统疾病（16.8%）。粪肠球菌（51.9%）和屎肠球菌（41.6%）是最常见的分离菌株，VRE检出率为10.9%，主要见于屎肠球菌分离株。年龄较大、既往VRE定植、屎肠球菌感染、全胃肠外营养（TPN）使用及持续性菌血症显著增加VRE感染风险。30天总死亡率为9.0%，随访期间总死亡率达20.7%。30天死亡率的独立预测因素为既往使用碳青霉烯类药物（OR = 3.2），而总体死亡率与接受TPN（OR = 1.9）、入住重症监护病房（ICU）（OR = 6.5）、持续性菌血症（OR = 3.6）及既往使用万古霉素（OR = 2.2）显著相关。
儿科EBSI与显著合并症及死亡率相关。VRE的存在、持续性感染及既往使用广谱抗生素增加死亡风险，凸显了抗菌药物管理和基于风险的管理的必要性。
