title: Clinical characteristics and risk factors for attributable mortality in Enterobacter cloacae bacteremia.
abstract: OBJECTIVE
  Enterobacter spp. have emerged as an important cause of nosocomial bacteremia. The purpose of this study was to delineate the clinical, laboratory and microbiologic features that may influence prognosis of Enterobacter cloacae and enable a stratification of those patients at high risk of mortality.
  
  
  METHODS
  This retrospective study reviewed 108 episodes of E. cloacae bacteremia occurring over a 2-year period (November 2001 to October 2003) at Taipei Veterans General Hospital. Univariate analysis were performed to demonstrate the relation of possible risk factors to death attributable to E. cloacae bacteremia.
  
  
  RESULTS
  Ninety-three episodes (86.1%) were hospital-acquired. The most common portal of entry was the genitourinary tract (17.9%) followed by the gastrointestinal tract (15.1%). Underlying diseases associated with E. cloacae bacteremia were neoplastic diseases (42 episodes, 38.9%), diabetes mellitus (20 episodes, 18.5%) and chronic renal failure (18 episodes, 16.7%). The overall mortality rate was 42.6%, and E. cloacae bacteremia-attributable mortality occurred in 22 patients (20.9%). Factors significantly correlated with death attributable to bacteremia were older age, a higher medium number of underlying diseases, hemoglobin <10 g/dL, serum C-reactive protein >10 mg/dL, hypoalbuminemia, disseminated intravascular coagulation, septic shock, respiratory failure, renal failure (creatinine >2 mg/dL) and delayed clinical response after initiation of antibiotic therapy.
  
  
  CONCLUSIONS
  Antibiotic-resistant isolates and appropriate empirical antibiotic use were not independent predictors of mortality in this study. The condition of patients at onset of symptoms and presence of underlying diseases appear to be important predictors mortality from E. cloacae bacteremia.
authors.affiliation: Department of Medicine, Taichung Hospital, Department of Health, The Executive Yuan, Taichung, Taiwan.
authors.forename: Yi Chun
authors.initials: YC
authors.lastname: Lin
authors.forename: Te Li
authors.initials: TL
authors.lastname: Chen
authors.forename: Huang Ling
authors.initials: HL
authors.lastname: Ju
authors.forename: Huan Shen
authors.initials: HS
authors.lastname: Chen
authors.forename: Fu Der
authors.initials: FD
authors.lastname: Wang
authors.forename: Kwok Woon
authors.initials: KW
authors.lastname: Yu
authors.forename: Chen Yi
authors.initials: CY
authors.lastname: Liu
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000494:pharmacology; D016470:Bacteremia / Q000150:complications / Q000382:microbiology / Q000401:mortality*; D001769:Blood / Q000382:microbiology; D002648:Child; D003428:Cross Infection / Q000382:microbiology / Q000401:mortality; D003470:Culture Media; D016972:Enterobacter cloacae / Q000187:drug effects / Q000302:isolation & purification; D004756:Enterobacteriaceae Infections / Q000150:complications / Q000382:microbiology / Q000401:mortality*; D005260:Female; D006801:Humans; D008297:Male; D008826:Microbial Sensitivity Tests; D008875:Middle Aged; D011379:Prognosis; D012307:Risk Factors
chemical_list: D000900:Anti-Bacterial Agents; D003470:Culture Media