Enterobacter Bacteremia Research Articles

Experience with Enterobacter bacteraemia in a Dublin teaching hospital

In a review of Enterobacter bacteraemia in a 600-bedded teaching hospital, 22 episodes were identified in 20 patients over a 2-year period. An evaluation of risk factors suggested an association between Enterobacter infection and the presence of central venous catheters or use of H-2 receptor antagonists. These factors together with previous exposure of the patient to gentamicin, and prolonged stay in the intensive care unit, increased the likelihood of gentamicin-resistant Enterobacter bacteraemia. This finding has implications for the choice of antibiotic regimen in the empirical treatment of suspected Gram-negative septicaemia.

Retrospective 6-year study of enterobacter bacteraemia in a Danish university hospital

In order to study the epidemiology of invasive enterobacter infections, data from 53 consecutive cases of bacteraemia due to this organism were compared with data from 72 randomly selected cases of Escherichia coli bacteraemia. The cases occurred among patients admitted to a Danish University hospital over a 6-year period. Forty-eight cases were due to Enterobacter cloacae and five were due to Ent. aerogenes. Enterobacter bacteraemia was more often of nosocomial origin than E. coli bacteraemia and more often polymicrobial. Patients suffering from enterobacter bacteraemia were younger than E. coli patients, and males tended to predominate. Apart from cancer of the prostate, other malignant diseases tended to be more frequent among patients with enterobacter bacteraemia than among E. coli patients. Enterobacter bacteraemia was more often associated with a focus in central venous catheters and burns, whereas patients with E. coli bacteraemia more often showed a focus of infection in the urinary tract. Patients with enterobacter bacteraemia and a microbiologically documented focus in the respiratory tract or the urinary tract more often had an endotracheal tube or indwelling urinary catheter compared to patients with E. coli bacteraemia with a similar focus of infection. In patients with no microbiologically documented focus enterobacter bacteraemia was more often associated with the presence of central and peripheral venous catheters. During the preceding 12 weeks patients with enterobacter bacteraemia, more often than E. coli patients, had been treated with β-lactam antibiotics, especially penicillins. The close association with devices may indicate that Enterobacter has a special affinity for foreign body material. Studies are planned to elucidate this aspect in further detail.

Enterobacter Bacteremia: Clinical Features and Emergence of Antibiotic Resistance during Therapy

To study the effect of previously administered antibiotics on the antibiotic susceptibility profile of Enterobacter, the factors affecting mortality, and the emergence of antibiotic resistance during therapy for Enterobacter bacteremia. Prospective, observational study of consecutive patients with Enterobacter bacteremia. Three university tertiary care centers, one major university-affiliated hospital, and two university-affiliated Veterans Affairs medical centers. A total of 129 adult patients were studied. The two main end points were emergence of resistance during antibiotic therapy and death. Previous administration of third-generation cephalosporins was more likely to be associated with multiresistant Enterobacter isolates in an initial, positive blood culture (22 of 32, 69%) than was administration of antibiotics that did not include a third-generation cephalosporin (14 of 71, 20%; P less than 0.001). Isolation of multiresistant Enterobacter sp. in the initial blood culture was associated with a higher mortality rate (12 of 37, 32%) than was isolation of a more sensitive Enterobacter sp. (14 of 92, 15%; P = 0.03). Emergence of resistance to third-generation cephalosporin therapy (6 of 31, 19%) occurred more often than did emergence of resistance to aminoglycoside (1 of 89, 0.01%; P = 0.001) or other beta-lactam (0 of 50; P = 0.002) therapy. More judicious use of third-generation cephalosporins may decrease the incidence of nosocomial multiresistant Enterobacter spp., which in turn may result in a lower mortality for Enterobacter bacteremia. When Enterobacter organisms are isolated from blood, it may be prudent to avoid third-generation cephalosporin therapy regardless of in-vitro susceptibility.

Bacteremia Caused by Enterobacter: 15 Years of Experience in a Cancer Hospital

A total of 296 episodes of bacteremia due to Enterobacter occurred in 281 patients with cancer between 1972 and 1986. The majority of these episodes were caused by Enterobacter cloacae. Seventy-four percent of the patients developed their infection while in the hospital and 55% had received therapeutic antibiotics during the 10 days preceding the onset of the infection. Enterobacter bacteremia was associated with shock in 24% of the patients and with disseminated intravascular coagulation in only 3%. The overall rate of response to therapy was 79% and increased to 85% during the last 5-year period. Only five patients remained afebrile during their infection, but four of these five died. Only 37% of the patients with shock responded to therapy compared with 93% of the patients without shock. The rate of response to therapy was 86% among patients without pulmonary infection compared with only 53% among those with pulmonary infection. The response rate to therapy with a single antibiotic was 73% and that to therapy with two antibiotics was 85%. As single therapeutic agents aminoglycosides were less effective than beta-lactam agents.

-Lactam-Resistant Enterobacter Bacteremia in Febrile Neutropenic Patients Receiving Monotherapy

Bacteremia with resistant Enterobacter species has been reported in febrile, neutropenic cancer patients receiving beta-lactam antibiotics. To assess the relationship between enterobacter bacteremia and ceftazidime monotherapy, medical records were reviewed and isolates were tested from 16 neutropenic and 35 nonneutropenic patients with Enterobacter bacteremia. Fifteen isolates from the neutropenic patients were resistant to extended spectrum cephalosporins; only 12 of 35 isolates from the nonneutropenic patients were resistant to Enterobacter species. The neutropenic patients also had more beta-lactam therapy, both immediately before bacteremia and in the preceding year, than did nonneutropenic patients. Prior beta-lactam antibiotic exposure may predispose neutropenic patients to develop resistant Enterobacter bacteremia.

Enterobacter Bacteremia in Pediatric Patients

Enterobacter has emerged as an important human pathogen, particularly in sick, hospitalized patients. Previous reports of nonepidemic enterobacter bacteremia have focused on adult patients. In this report, the epidemiologic factors, clinical characteristics, treatment, and outcome for 33 patients with enterobacter bacteremia in a large children's hospital during a 5-year period are reviewed. The ratio of males to females was 1.2:1. The patients' ages ranged from 2 days to 24 years, and 18 patients were less than 18 months old. Twenty-two cases were nosocomially acquired; six were polymicrobial in nature. Significantly underlying conditions were present in 32 patients. The biliary tract and central venous catheters were the most common sources of bacteremia. Two-thirds of patients had preceding antibiotic therapy. The overall mortality was 24%; mortality attributable to enterobacter bacteremia was 18%. Statistically significant differences in mortality were associated with an age less than 18 months (P = .031) or thrombocytopenia (P = .017); presence of fever was of borderline significance (P = .098). Enterobacter bacteremia is an important cause of morbidity and mortality in pediatric patients.

Enterobacter bacteremia: a review of 58 episodes.

This report reviews 58 episodes of enterobacter bacteremia in 55 patients during a 66-month period at a 750-bed community teaching hospital in USA. The median age of patients was 65 years and 38% of the patients were older than 70 years. All patients had underlying conditions: rapidly fatal (7%), ultimately fatal (33%) and non-fatal (60%). Nosocomial acquisition of bacteremia occurred in 72% of episodes. 20 episodes (34.5%) were polymicrobial bacteremia. The major portal of entry was the lungs (34%). The overall mortality was 69%. Factors that adversely influenced the mortality rate were nosocomial acquisition (p less than 0.02), rapidly fatal and ultimately fatal underlying conditions (p less than 0.02), and lungs as the portal of entry (p less than 0.05).

<I>Enterobacter</I>属による菌血症の臨床細菌学的検討

This paper reviews the clinical and bacteriological features of patients with Enterobacter bacteremia at Juntendo University Hospital in Tokyo during a 5 year period from 1979 to 1983. E. cloacae was most frequently isolated among Enterobacter species.Most of the patients were in the early or later stages of life: 9 infants were under one year of age and 12 patients were 50 years of age or older. One or more underlying diseases were found in all of 27 patients: malignancy in 14 patients, congeniatal anomary in 8 infants and liver cirrhosis and diabetes mellitus in 3 patients either.During the hospital course, acute complications;septic shock and/or disseminated intravascular coaguration occured in 4 and 5 patients, respectively and were fatal in all.Of 63%(17/27) of the patients who died, bacteremia was responsible in 11 and underlying disease was responsible in 6.Ampicillin, cefazoline, cefmetazole and cefotiam were not effective for most isolates of E. cloacae from blood of the patients, whereas gentamicin, nalidixic acid, chloramphenicol and minocycline were effecive.Enterobacter bacteremia is an opportunistic infection and noscocomial infection in hospitalized patients.

Enterobacter bacteremia. An analysis of 50 episodes.

During a six-year period, 147 patients had Enterobacter bacteremia (3.8% of the episodes of bacteremia), with an incidence of 1.25 per 1,000 admitted patients. We chose a random group of 50 cases for analysis. The disease was community acquired in 24% of the cases and nosocomially acquired in the remaining 76%. The bacteremia was unimicrobial in 70% and part of a polymicrobial bacteremia in 30%. The species most commonly causing bacteremia was Enterobacter cloacae. Portals of entry, in decreasing order of frequency, were unknown, surgical wound, respiratory tract, and urinary tract. The most common clinical finding was fever (92%). Shock occurred in 30% of the patients, and only two patients had evidence of disseminated intravascular coagulation. Of the Enterobacter isolates, 12% were resistant to gentamicin. Overall mortality was 42%; factors associated with a poor prognosis were inadequacy of antimicrobial chemotherapy, septic shock, type of underlying disease, clinical condition, and requirement of intensive care.