title: Enterobacter bacteremia: Clinical features, risk factors for multiresistance and mortality in a Chinese University Hospital.
abstract: BACKGROUND
  This study was performed to characterize the clinical features and to identify the risk factors for multiresistance and mortality in patients with Enterobacter bacteremia.
  
  
  METHODS
  A number of 126 patients with Enterobacter bacteremia in 1995-2004 at the Medical university-affiliated Hospital of Anhui, China were retrospectively analyzed.
  
  
  RESULTS
  Of the 126 cases of bacteremia, 81 (64.3%) patients were identified as nosocomial infection. The overall multiresistance rate was 45.2% (57/126). Multiresistance was associated with nosocomial infection, recent invasive procedure, previous third-generation cephalosporins therapy, prolonged perioperative prophylaxis, the species of Enterobacter (E. cloacae) and polymicrobial bacteremia in univariate analysis. In multivariate analysis, previous third-generation cephalosporins therapy (OR = 13.6, p = 0.007) and prolonged perioperative prophylaxis (OR = 6.4, p = 0.029) were the strong, independent risk factors for the multiresistance. The crude 30-day mortality rate was 39.7% (50/126). Mortality directly attributed to Enterobacter spp. was 32.5% (41/126), which was significantly associated with multiresistance, nosocomial infection, recent invasive procedure, and inadequately empirical therapy in univariate analysis. Multivariate analysis revealed that only nosocomial infection (OR = 3.292, p = 0.049) was independently associated with mortality. The survival curve showed that the inappropriate initial therapy group had a lower probability of survival than the appropriate therapy group in infection-related mortality (Log Rank, p = 0.0142).
  
  
  CONCLUSIONS
  Enterobacter is becoming increasingly important nosocomial pathogens. Nosocomial infection is a clinical risk factor tightly associated with multiresistance and worse outcome. More judicious use of third-generation cephalosporins may decrease the incidence of nosocomial multiresistant Enterobacter spp. in China.
authors.affiliation: Dept. of Epidemiology and Health Statistics, Anhui Medical University, Hefei 230022, People's Republic of China.
authors.forename: Y
authors.initials: Y
authors.lastname: Ye
authors.forename: J B
authors.initials: JB
authors.lastname: Li
authors.forename: D Q
authors.initials: DQ
authors.lastname: Ye
authors.forename: Z J
authors.initials: ZJ
authors.lastname: Jiang
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D016470:Bacteremia / Q000188:drug therapy* / Q000382:microbiology / Q000401:mortality; D002648:Child; D002675:Child, Preschool; D003428:Cross Infection / Q000188:drug therapy* / Q000382:microbiology / Q000401:mortality; D024901:Drug Resistance, Multiple, Bacterial; D004754:Enterobacter / Q000187:drug effects*; D004756:Enterobacteriaceae Infections / Q000188:drug therapy* / Q000382:microbiology / Q000401:mortality; D005260:Female; D006785:Hospitals, University; D006801:Humans; D007223:Infant; D008297:Male; D008826:Microbial Sensitivity Tests; D008875:Middle Aged; D012307:Risk Factors
chemical_list: D000900:Anti-Bacterial Agents