Growing Relevance of Vancomycin Resistant Enterococci in Neonates: A Rising Thunder in Intensive Care Units

Background: Neonatal septicemia is a severe life-threatening bacteremia in which multiplying bacteria release toxins into the blood stream which increases production of cytokines causing clinical manifestations like fever, chills, tissue anoxia, reduced blood pressure, collapse etc. Enterococci are one of the important global pathogens in neonatal septicemia and were considered colonizers in the past. Their gaining resistance has been highlighted mainly to Vancomycin and high level aminoglycosides.

Aim: This study was carried out to emphasize the growing relevance of multi-drug-resistant Enterococci in newborns, which were previously solely non-harmful colonists.

Materials and Methods: It was a retrospective study in which blood culture samples from the neonatal intensive care unit received in the laboratory were considered. Processing of samples and identification of organisms were done as per standard guidelines.

Results: Enterococci accounted for 16% of the isolation rate. 78% of them showed early onset septicemia with male predominance. Vancomycin resistance Enterococci (VRE)was observed in only one isolate (11%) while high level aminoglycoside resistance was observed in 80% of them. Clinical history suggested low birth weight, prematurity, fever, catheterization and raised C- reactive protein levels.

Conclusions: The study shows an upsurge of VRE and highlevel aminoglycoside resistance (HLAR) in neonatal septicemia with the need for periodic training and active surveillance culture program for rapid identification of colonizers as the main cause of bacteremia and increase awareness amongst the health care workers about the rising multi drug resistant infectious incidence of Enterococci.