Enterobacter bacteremia: Clinical features, risk factors for multiresistance and mortality in a Chinese University Hospital.

BACKGROUND

This study was performed to characterize the clinical features and to identify the risk factors for multiresistance and mortality in patients with Enterobacter bacteremia.

PATIENTS AND METHODS

A number of 126 patients with Enterobacter bacteremia in 1995-2004 at the Medical university-affiliated Hospital of Anhui, China were retrospectively analyzed.

RESULTS

Of the 126 cases of bacteremia, 81 (64.3%) patients were identified as nosocomial infection. The overall multiresistance rate was 45.2% (57/126). Multiresistance was associated with nosocomial infection, recent invasive procedure, previous third-generation cephalosporins therapy, prolonged perioperative prophylaxis, the species of Enterobacter (E. cloacae) and polymicrobial bacteremia in univariate analysis. In multivariate analysis, previous third-generation cephalosporins therapy (OR = 13.6, p = 0.007) and prolonged perioperative prophylaxis (OR = 6.4, p = 0.029) were the strong, independent risk factors for the multiresistance. The crude 30-day mortality rate was 39.7% (50/126). Mortality directly attributed to Enterobacter spp. was 32.5% (41/126), which was significantly associated with multiresistance, nosocomial infection, recent invasive procedure, and inadequately empirical therapy in univariate analysis. Multivariate analysis revealed that only nosocomial infection (OR = 3.292, p = 0.049) was independently associated with mortality. The survival curve showed that the inappropriate initial therapy group had a lower probability of survival than the appropriate therapy group in infection-related mortality (Log Rank, p = 0.0142).

CONCLUSION

Enterobacter is becoming increasingly important nosocomial pathogens. Nosocomial infection is a clinical risk factor tightly associated with multiresistance and worse outcome. More judicious use of third-generation cephalosporins may decrease the incidence of nosocomial multiresistant Enterobacter spp. in China.