Enterobacter hormaechei as an Increasing Cause of Neonatal Sepsis: A Case Series and Literature Review

Aims: The aim of our paper is to present antenatal, perinatal and postnatal characteristics of neonates, as well as course of neonatal sepsis caused by Enterobacter hormaechei. The main goal is to consider options for improving the prevention of this infection. Presentation of Cases: Five neonates with Enterobacter hormaechei sepsis were included. Three neonates were female. All the neonates were born prematurely, four of them were extremely preterm, with birth weight less than 1000 g. The mean gestational age was 27.4 weeks and mean birth weight was 1234 g. Two of these neonates were from multiple pregnancies. Four neonates had late-onset sepsis and one had early-onset sepsis caused by Enterobacter hormaechei. One neonate had meningitis caused this bacterium. Ampicillin and aminoglycoside had been given to all neonates, before Enterobacter hormaechei sepsis. Enterobacter hormaechei sensitive to carbapenems was isolated in blood culture. The course of sepsis was favorable in all neonates, without fatal outcome. Discussion: The main risk factors for neonatal sepsis are prematurity and low birth weight. Gram-negative bacteria of the genus Enterobacter cause nosocomial infections in neonatal intensive care units. The reservoir of infection could be the intestine of neonates. The first report cases of sepsis caused by Enterobacter hormaechei was in Brazil, especially in preterm neonates with birth weight less than 2500 g. Enterobacter bloodstream infection has been related to previous use of antibiotics. Conclusion: There is a need hand hygiene of healthcare workers, disinfection of hospital rooms and equipment, as well as rational use of antibiotics in neonatal intensive care units. Carbapenems are the first-line antibiotics for treatment neonatal infections caused by Enterobacter hormaechei.