Group D streptococcal bacteremia in children. A review of 72 cases in 12 years.

A review was conducted of 72 cases of pediatric group D streptococcal (GDS) bacteremia treated at our institution during a 12-year period. These 72 cases represented 90% of all instances in which this organism was isolated by blood culture (in eight others, GDS was considered a contaminant); the rate of isolation of this organism relative to all positive blood cultures during this time period was 1.3%. Infection was nosocomially acquired in 25 cases; 18 occurred in an intensive care unit. At the time their positive blood culture was obtained, 25 patients were afebrile and 10 patients were receiving parenteral antibiotic therapy to which the isolate exhibited in vitro susceptibility. In 31 cases, GDS was isolated by blood culture in conjunction with another organism, most frequently Staphylococcus epidermidis. Underlying medical conditions or foci of infection associated with GDS bacteremia were identified in 65 patients; the most common were the presence of an indwelling central venous catheter (23), a variety of lesions of the gastrointestinal tract (21), and pulmonary infiltrate (15). Bacteremia was associated with GDS meningitis in three patients who had had no prior neurosurgical procedure. The overall mortality rate was 20%; nearly two thirds of all deaths occurred in patients younger than 1 year of age.