Clinical characteristics and risk factors for attributable mortality in Enterobacter cloacae bacteremia.
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.
Lin
Yi Chun
YC
Department of Medicine, Taichung Hospital, Department of Health, The Executive Yuan, Taichung, Taiwan.
Chen
Te Li
TL
Ju
Huang Ling
HL
Chen
Huan Shen
HS
Wang
Fu Der
FD
Yu
Kwok Woon
KW
Liu
Chen Yi
CY
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
D000900:Anti-Bacterial Agents; D003470:Culture Media