Clinical features and therapeutic implications of 104 episodes of monomicrobial Aeromonas bacteraemia.
OBJECTIVE
Aeromonas bacteraemia is not a common infectious disease, but can cause a grave outcome in infected cases. In this study, clinical presentations and prognostic factors of cases of monomicrobial Aeromonas bacteraemia were analysed. Also, the impact of beta-lactam and aminoglycoside in combination and of emerging cephalosporin-resistance during therapy was discussed.


METHODS
From 1989 to 1998 in a medical centre in southern Taiwan, those cases with monomicrobial Aeromonas bacteraemia were included for study.


RESULTS
A total of 104 episodes of monomicrobial Aeromonas bacteraemia, accounting for 74% of all Aeromonas bacteraemia, were encountered. The infections usually occurred in the patients with hepatic cirrhosis (54%) or malignancy (21%) and were community-acquired (74%). Cases of community-acquired bacteraemia were more likely to have cirrhosis, a high severity score at onset, and a worse prognosis than those of nosocomial bacteraemia did and nosocomial isolates were less susceptible to cefoxitin and cefotaxime. Forty-three percent of cases had a concomitant infection focus, such as primary peritonitis, invasive cellulitis or necrotizing fasciitis, biliary tract or burn wound infections. Crude fatality rate within 2 weeks after the onset was 30%. Secondary bacteraemia and a higher severity score ( > or = 4) for illness at the first presentation were independently associated with a fatal outcome. The therapeutic superiority of beta-lactam and aminoglycoside in combination cannot be demonstrated in patients with Aeromonas bacteraemia. Cefotaxime resistance emerged in 3.4% of 58 patients treated with a cephalosporin for at least 72 h. None of the community-acquired isolates, but one-quarter of the nosocomial isolates, were resistant to cefotaxime.


CONCLUSIONS
Aeromonas bacteraemia usually occurred in patients with liver cirrhosis or malignancy, and heralded a poor prognosis, especially while associated with a relevant infectious source or with a higher severity score at presentation. The superiority of aminoglycoside and beta-lactam in combination cannot be demonstrated while treating those patients, and the emergence of antimicrobial resistance to cephalosporin was a rare event during cephalosporin therapy. Thus, a broad-spectrum cephalosporin remains one of the antimicrobial alternatives for invasive community-acquired Aeromonas infections.
Ko
W C
WC
Department of Internal Medicine, National Cheng Kung University Hospital, Tainan, Taiwan.
Lee
H C
HC
Chuang
Y C
YC
Liu
C C
CC
Wu
J J
JJ
D000293:Adolescent; D000328:Adult; D000333:Aeromonas; D000368:Aged; D000617:Aminoglycosides / Q000627:therapeutic use; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D016470:Bacteremia / Q000175:diagnosis / Q000188:drug therapy* / Q000401:mortality*; D002439:Cefotaxime / Q000627:therapeutic use; D018550:Cephalosporin Resistance; D002511:Cephalosporins / Q000627:therapeutic use; D017714:Community-Acquired Infections / Q000175:diagnosis / Q000188:drug therapy / Q000401:mortality; D003428:Cross Infection / Q000175:diagnosis / Q000188:drug therapy / Q000401:mortality; D004359:Drug Therapy, Combination / Q000627:therapeutic use; D005260:Female; D016905:Gram-Negative Bacterial Infections / Q000175:diagnosis / Q000188:drug therapy* / Q000401:mortality*; D006801:Humans; D007769:Lactams / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012307:Risk Factors
D000617:Aminoglycosides; D000900:Anti-Bacterial Agents; D002511:Cephalosporins; D007769:Lactams; D002439:Cefotaxime