A prospective, multicenter case control study of risk factors for acquisition and mortality in Enterobacter species bacteremia - 05/02/20
Spanish Network for Research in Infectious Diseases/Enterobacter spp. Bacteriemia Project group
Highlights |
• | Invasive devices, antibiotics and ICU stay predispose to acquire an Enterobacter bacteremia. |
• | Enterobacter bacteremia increased mortality in patients with comorbidities or a severe infection. |
• | The outcome was not affected by antibiotic resistances of the isolates or the antibiotic therapy. |
Abstract |
Background |
Enterobacter is among the main etiologies of hospital-acquired infections. This study aims to identify the risk factors of acquisition and attributable mortality of Enterobacter bacteremia.
Methods |
Observational, case-control study for risk factors and prospective cohort for outcomes of consecutive cases with Enterobacter bacteremia. This study was conducted in five hospitals in Spain over a three-year period. Matched controls were patients with negative blood cultures and same sex, age, and hospitalization area.
Results |
The study included 285 cases and 570 controls. E. cloacae was isolated in 198(68.8%) cases and E. aerogenes in 89(31.2%). Invasive procedures (hemodialysis, nasogastric tube, mechanical ventilation, surgical drainage tube) and previous antibiotics or corticosteroids were independently associated with Enterobacter bacteremia. Its attributable mortality was 7.8%(CI95%2.7–13.4%), being dissimilar according to a McCabe index: non-fatal=3.2%, ultimately fatal=12.9% and rapidly fatal=0.12%. Enterobacter bacteremia remained an independent risk factor for mortality among cases with severe sepsis or septic shock (OR 5.75 [CI95%2.57–12.87], p<0.001), with an attributable mortality of 40.3%(CI95%25.7–53.3). Empiric therapy or antibiotic resistances were not related to the outcome among patients with bacteremia.
Conclusions |
Invasive procedures, previous antibiotics and corticosteroids predispose to acquire Enterobacter bacteremia. This entity increases mortality among fragile patients and those with severe infections. Antibiotic resistances did not affect the outcome.
Le texte complet de cet article est disponible en PDF.Keywords : Case-control study Enterobacter spp. Bacteremia, Enterobacter spp. Bacteremia, Enterobacter cloacae, Enterobacter aerogenes, Mortality Enterobacter spp. Bacteremia, Risk factors Enterobacter spp. Bacteremia
Plan
Vol 80 - N° 2
P. 174-181 - février 2020 Retour au numéro
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