Clinical impact and risk factors of enterococcal bacteremia in children: a focus on vancomycin resistance and mortality.

Background: 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.

Methods: 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.

Results: 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).

Conclusion: 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.