Lin Yi Chun, Chen Te Li, Ju Huang Ling, Chen Huan Shen, Wang Fu Der, Yu Kwok Woon, Liu Chen Yi
Department of Medicine, Taichung Hospital, Department of Health, The Executive Yuan, Taichung, Taiwan.
J Microbiol Immunol Infect. 2006 Feb;39(1):67-72.
Enterobacter spp. have emerged as an important cause of nosocomial bacteremia. The purpose of this study was to delineate the clinical, laboratory and microbiologic features that may influence prognosis of Enterobacter cloacae and enable a stratification of those patients at high risk of mortality.
This retrospective study reviewed 108 episodes of E. cloacae bacteremia occurring over a 2-year period (November 2001 to October 2003) at Taipei Veterans General Hospital. Univariate analysis were performed to demonstrate the relation of possible risk factors to death attributable to E. cloacae bacteremia.
Ninety-three episodes (86.1%) were hospital-acquired. The most common portal of entry was the genitourinary tract (17.9%) followed by the gastrointestinal tract (15.1%). Underlying diseases associated with E. cloacae bacteremia were neoplastic diseases (42 episodes, 38.9%), diabetes mellitus (20 episodes, 18.5%) and chronic renal failure (18 episodes, 16.7%). The overall mortality rate was 42.6%, and E. cloacae bacteremia-attributable mortality occurred in 22 patients (20.9%). Factors significantly correlated with death attributable to bacteremia were older age, a higher medium number of underlying diseases, hemoglobin <10 g/dL, serum C-reactive protein >10 mg/dL, hypoalbuminemia, disseminated intravascular coagulation, septic shock, respiratory failure, renal failure (creatinine >2 mg/dL) and delayed clinical response after initiation of antibiotic therapy.
Antibiotic-resistant isolates and appropriate empirical antibiotic use were not independent predictors of mortality in this study. The condition of patients at onset of symptoms and presence of underlying diseases appear to be important predictors mortality from E. cloacae bacteremia.
阴沟肠杆菌已成为医院获得性菌血症的重要病因。本研究旨在描述可能影响阴沟肠杆菌感染预后的临床、实验室及微生物学特征，并对高死亡风险患者进行分层。
本回顾性研究分析了台北荣民总医院在2年期间（2001年11月至2003年10月）发生的108例阴沟肠杆菌菌血症病例。进行单因素分析以显示可能的危险因素与阴沟肠杆菌菌血症所致死亡的关系。
93例（86.1%）为医院获得性感染。最常见的感染途径是泌尿生殖道（17.9%），其次是胃肠道（15.1%）。与阴沟肠杆菌菌血症相关的基础疾病有肿瘤性疾病（42例，38.9%）、糖尿病（20例，18.5%）和慢性肾功能衰竭（18例，16.7%）。总体死亡率为42.6%，22例患者（20.9%）死于阴沟肠杆菌菌血症。与菌血症所致死亡显著相关的因素包括年龄较大、基础疾病数量较多、血红蛋白<10 g/dL、血清C反应蛋白>10 mg/dL、低白蛋白血症、弥散性血管内凝血、感染性休克、呼吸衰竭、肾衰竭（肌酐>2 mg/dL）以及抗生素治疗开始后临床反应延迟。
在本研究中，抗生素耐药菌株和适当的经验性抗生素使用并非死亡的独立预测因素。症状出现时患者的状况及基础疾病的存在似乎是阴沟肠杆菌菌血症死亡的重要预测因素。
