Neonatal sepsis caused by enterobacter amnigenus

lsolation of Enterobacter amnigenus from a human source is extremely rare. We report for the first time in literature the isolation of Enterobacter amnigenus from the blood of 5 prematüre infants. Characteristics of the patients are presented in the table. First 4 patients were parts of quintuplets pregnancy, the fifth sibling was not symptomatic and her cultures were negative. All the infants had signs and symptoms of sepsis, which prompted comprehensive investigations and treatment with antibiotics and supportive measures, one of the quintuplets was asymptomatic. All had umbilical catheters and were on mechanical ventilation. Enterobacter amnigenus was isolated from both the aerobic and anaerobic blood culture bottles in 8 occasions. Repeated blood culture from three patients grew again Enterobacter amnigenus while they were on antibiotics . Cultures from other sites including urine, cerebrospinal fluid, stool and endotracheal tube were negative in all patients.

After the cultures were taken, the patients were initially given cefotaxime and amikacin intravenously (n=4 ), and 1 patient ampicillin and amikacin. Three patients continued to be symptomatic and repeated blood cultures grew Enterobacter amnigenus again. imipenem was given instead of cefotaxime (n=2) and repeated blood cultures were negative. MICs studies were performed on the isolates. All patients survived. Inspite of exlensive epidemiological investigations we could not identify the initial source of infection except that three of the patients had been transfused with packed RBCs taken from one blood bag. A sample of that blood was not available for culture. We conelude that Enterobacter amnigenus can cause neonatal sepsis, and aggressive treatment with the appropriate antibiotics and supportive measures are required.