Section of Infectious Diseases, Department of Internal Medicine, Wei Gong Memorial General Hospital, Miaoli, Taiwan.
J Microbiol Immunol Infect. 2009 Aug;42(4):329-35.
Enterobacter aerogenes is increasingly encountered in nosocomial infections. This study aimed to clarify the clinical characteristics and to identify the predictors of mortality in patients with E. aerogenes bacteremia.
From March 2001 to April 2007, all patients with positive blood cultures for E. aerogenes at Taipei Veterans General Hospital, Taipei, Taiwan, were enrolled in this retrospective study. The medical records were reviewed for clinical and laboratory data.
Eighty eight patients were included, 9 (10.2%) of whom died of E. aerogenes bacteremia. Most of the patients had comorbidities. Seventy nine patients (89.8%) had nosocomial infections, and 43 patients (48.9%) had polymicrobial infections. Eighty four patients (95.5%) presented with fever. Empirical antimicrobial therapy was administered for 80 patients (90.9%), but was appropriate for only 55 patients (62.5%). Of the 9 patients who died, 8 had polymicrobial infection, 5 of whom had nosocomial pneumonia, and 6 did not receive appropriate antimicrobial therapy. Multivariate analysis indicated that high Acute Physiology and Chronic Health Evaluation (APACHE) II score (>16) [odds ratio (OR), 16.569; 95% confidence interval (CI), 1.24-221.24; p = 0.034] and strains not susceptible to extended-spectrum cephalosporins (OR, 9.21; 95% CI, 1.02-83.04; p = 0.048) were independent risk factors for mortality.
The severity of E. aerogenes bacteremia, reflected by high APACHE II score and isolation of strains with no susceptibility to extended-spectrum cephalosporins, were independent risk factors for mortality. Patients with severe illness and isolates resistant to extended-spectrum cephalosporins should be treated with more potent antimicrobial agents.
产气肠杆菌在医院获得性感染中越来越常见。本研究旨在阐明产气肠杆菌菌血症患者的临床特征，并确定其死亡的预测因素。
本研究回顾性分析了 2001 年 3 月至 2007 年 4 月期间，于台湾台北荣民总医院经血液培养确诊为产气肠杆菌感染的所有患者。分析其临床和实验室数据。
共纳入 88 例患者，其中 9 例（10.2%）因产气肠杆菌菌血症死亡。大多数患者患有合并症。79 例（89.8%）为医院获得性感染，43 例（48.9%）为混合菌感染。84 例（95.5%）患者表现为发热。80 例（90.9%）患者接受了经验性抗菌治疗，但仅有 55 例（62.5%）的治疗方案恰当。9 例死亡患者中，8 例为混合菌感染，其中 5 例患有医院获得性肺炎，6 例未接受恰当的抗菌治疗。多因素分析表明，高急性生理学和慢性健康评估（APACHE）Ⅱ评分（>16）[比值比（OR），16.569；95%置信区间（CI），1.24-221.24；p=0.034]和菌株对头孢菌素类药物不敏感（OR，9.21；95%CI，1.02-83.04；p=0.048）是死亡的独立危险因素。
APACHE Ⅱ评分较高和分离株对头孢菌素类药物不敏感反映了产气肠杆菌菌血症的严重程度，是死亡的独立危险因素。对于病情严重和分离株对头孢菌素类药物耐药的患者，应使用更有效的抗菌药物进行治疗。
