Clinical features and risk factors for mortality in Aeromonas bacteremic adults with hematologic malignancies.
OBJECTIVE
Aeromonas spp. often cause infections in immunocompromised patients. To specifically understand the clinical features of Aeromonas bacteremic adults with hematologic malignancies, we investigated the demographic, clinical and microbiologic characteristics of Aeromonas bacteremia in this patient population.


METHODS
Retrospective study performed in a tertiary medical center in southern Taiwan, in which adults with hematologic malignancies suffered from Aeromonas bacteremia admitted between 1995 and 2003 were included for study.


RESULTS
There were 45 episodes of Aeromonas bacteremia in 41 adults with hematologic malignancies. Episodes of Aeromonas bacteremia which occurred at least 2 months apart were counted as separate cases in the analysis. A total of 30 men and 15 women (mean age: 53.2 years), with 4 patients experiencing 2 episodes, was included. The 3 leading underlying hematologic malignancies were acute myelogenous leukemia (37.8%), myelodysplastic syndrome (26.7%) and non-Hodgkin's lymphoma (17.8%). No cluster of Aeromonas bacteremia was found during the study period. Twenty nine (64.4%) of the 31 patients with nosocomial Aeromonas bacteremia had received recent antineoplastic chemotherapy. The 3 leading clinical manifestations were fever (88.9%), septic shock (40%), and altered consciousness (26.7%). Eleven (24.4%) episodes of bacteremia were polymicrobial. Sixteen (35.6%) patients died within 14 days of onset of bacteremia. The mean duration from sampling blood for culture to death was 3.81 days. Altered consciousness (odds ratio, 8.999; 95% confidence interval, 1.787-45.33; p=0.008) was the only independent prognostic factor for mortality. High resistance rates (11.1% to piperacillin and 35.6% to imipenem) among Aeromonas isolates were also noted.


CONCLUSIONS
In febrile patients with hematologic malignancies and suspected Aeromonas infections, particular attention to the development of alteration of consciousness is needed as it is an independent risk factor for mortality.
Tsai
Moan-Shane
MS
Division of Infectious Diseases, Department of Internal Medicine, Chang Gung Memorial Hospital-Kaohsiung Medical Center, Chang Gung University, Kaohsiung, Taiwan.
Kuo
Ching-Yuan
CY
Wang
Ming-Chung
MC
Wu
Hong-Cheng
HC
Chien
Chun-Chih
CC
Liu
Jien-Wei
JW
D000333:Aeromonas / Q000302:isolation & purification*; D000368:Aged; D000369:Aged, 80 and over; D000970:Antineoplastic Agents / Q000627:therapeutic use; D016470:Bacteremia / Q000382:microbiology / Q000401:mortality* / Q000503:physiopathology*; D003244:Consciousness Disorders; D024881:Drug Resistance, Bacterial; D005260:Female; D005334:Fever; D016905:Gram-Negative Bacterial Infections / Q000382:microbiology / Q000401:mortality* / Q000503:physiopathology*; D019337:Hematologic Neoplasms / Q000150:complications*; D006761:Hospitals; D006801:Humans; D015378:Imipenem / Q000494:pharmacology; D015470:Leukemia, Myeloid, Acute / Q000150:complications / Q000188:drug therapy; D008228:Lymphoma, Non-Hodgkin / Q000150:complications / Q000188:drug therapy; D008297:Male; D008875:Middle Aged; D009190:Myelodysplastic Syndromes / Q000150:complications / Q000188:drug therapy; D010878:Piperacillin / Q000494:pharmacology; D011379:Prognosis; D012307:Risk Factors; D012772:Shock, Septic; D013624:Taiwan; D013997:Time Factors
D000970:Antineoplastic Agents; D015378:Imipenem; D010878:Piperacillin