Infections néonatales à Enterococcus fæcalis : analyse de 29 observations

Objective: Resistance of Enterococcus fæcalis to antibiotics has considerably increased and led to therapeutic difficulties. The purpose of our study is to specify the factors of risk of the Enterococcus fæcalis infection in a neonatal intensive care unit and to determine the sensitivity of isolate strains.

Methods: We retrospectively analyzed 29 cases, collected during 1996 and 1997. Two groups were compared according to χ² test: group 1 (acquisition of Enterococcus fæcalis infection), group 2 (asymptomatic bacteremia). The determination of isolate strains was based on the method of disks.

Results: The dominant clinical picture was severe in 38% ($\text{11}\text{29}$) of the cases. In 31% ($\text{9}\text{29}$) of cases, neurologic symptomes were predominant, and in 28% ($\text{8}\text{29}$) a respiratory distress was observed. The risk factors for acquiring an Enterococcus fæcalis infection were the administration of large spectrum antibiotics in $\text{14}\text{15}$ (93%) for group 1 vs $\text{6}\text{14}$ (43%) for group 2, and the frequent use of buccopharyngeal aspirations: $\text{6}\text{15}$ (40%) for group 1 vs $\text{1}\text{14}$ (7%) for group 2. Enterococcus fæcalis were resistant to penicillin G in 50%, to amoxicillin in 34%, and exhibited a high level of resistance to gentamicin in 87%; no case of resistance to vancomycin was observed. Mortality rate was 20% ($\text{3}\text{15}$) in group 1 and 7% ($\text{1}\text{14}$) in group 2.

Conclusion: Enterococcus fæcalis is a frequent cause of septicemia in critically ill newborns. The prevention of nosocomial infection by using the hygiene measures and a rational prescription of the antibiotics is underlined.