OBJECTIVE: To report two cases of severe early-onset neonatal sepsis due to Streptococcus pneumoniae, including, to our knowledge, the first reported case of sepsis due to penicillin-resistant S. pneumoniae presenting as early-onset neonatal sepsis. DESIGN: Case reports. SETTING: A level III military and civilian neonatal intensive care unit. PATIENTS: Two infants (gestational ages of 38 and 35 wks), both of whom presented shortly after birth with severe septic shock presumed to be due to group B streptococcus. INTERVENTIONS: Both infants were treated with high-frequency oscillatory ventilation and inhaled nitric oxide, with one infant requiring venoarterial extracorporeal membrane oxygenation. RESULTS: Cultures of blood specimens from both infants yielded S. pneumoniae. For one infant, antibiotic sensitivity testing demonstrated resistance to penicillin, erythromycin, and trimethoprim/sulfamethoxazole. After treatment, both infants recovered well with normal results of examinations and neural imaging studies at the time of hospital discharge. CONCLUSIONS: Clinicians should consider S. pneumoniae as a possible cause of fulminant nonresponsive sepsis in neonates. In areas where antimicrobial-resistant S. pneumoniae is prevalent, when culture results are known, or with a clinical course unresponsive to ampicillin, septic infants may require the addition of a penicillinase-resistant antibiotic to their therapeutic regimen until results of antibiotic sensitivity testing are known. Early transfer to a center with extracorporeal membrane oxygenation should be considered for symptomatic neonates.
OBJECTIVE: To report two cases of severe early-onset neonatal sepsis due to Streptococcus pneumoniae, including, to our knowledge, the first reported case of sepsis due to penicillin-resistant S. pneumoniae presenting as early-onset neonatal sepsis. DESIGN: Case reports. SETTING: A level III military and civilian neonatal intensive care unit. PATIENTS: Two infants (gestational ages of 38 and 35 wks), both of whom presented shortly after birth with severe septic shock presumed to be due to group B streptococcus. INTERVENTIONS: Both infants were treated with high-frequency oscillatory ventilation and inhaled nitric oxide, with one infant requiring venoarterial extracorporeal membrane oxygenation. RESULTS: Cultures of blood specimens from both infants yielded S. pneumoniae. For one infant, antibiotic sensitivity testing demonstrated resistance to penicillin, erythromycin, and trimethoprim/sulfamethoxazole. After treatment, both infants recovered well with normal results of examinations and neural imaging studies at the time of hospital discharge. CONCLUSIONS: Clinicians should consider S. pneumoniae as a possible cause of fulminant nonresponsive sepsis in neonates. In areas where antimicrobial-resistant S. pneumoniae is prevalent, when culture results are known, or with a clinical course unresponsive to ampicillin, septic infants may require the addition of a penicillinase-resistant antibiotic to their therapeutic regimen until results of antibiotic sensitivity testing are known. Early transfer to a center with extracorporeal membrane oxygenation should be considered for symptomatic neonates.