title: Severe community-acquired Enterobacter pneumonia: a plea for greater awareness of the concept of health-care-associated pneumonia.
abstract: BACKGROUND
  Patients with Enterobacter community-acquired pneumonia (EnCAP) were admitted to our intensive care unit (ICU). Our primary aim was to describe them as few data are available on EnCAP. A comparison with CAP due to common and typical bacteria was performed.
  
  
  METHODS
  Baseline clinical, biological and radiographic characteristics, criteria for health-care-associated pneumonia (HCAP) were compared between each case of EnCAP and thirty age-matched typical CAP cases. A univariate and multivariate logistic regression analysis was performed to determine factors independently associated with ENCAP. Their outcome was also compared.
  
  
  RESULTS
  In comparison with CAP due to common bacteria, a lower leukocytosis and constant HCAP criteria were associated with EnCAP. Empiric antibiotic therapy was less effective in EnCAP (20%) than in typical CAP (97%) (p < 0.01). A delay in the initiation of appropriate antibiotic therapy (3.3 ± 1.6 vs. 1.2 ± 0.6 days; p < 0.01) and an increase in duration of mechanical ventilation (8.4 ± 5.2 vs. 4.0 ± 4.3 days; p = 0.01) and ICU stay were observed in EnCAP patients.
  
  
  CONCLUSIONS
  EnCAP is a severe infection which is more consistent with HCAP than with typical CAP. This retrospectively suggests that the application of HCAP guidelines should have improved EnCAP management.
authors.affiliation: Medical Intensive Care Unit, Hôpital Pellegrin-Tripode, Place Amélie Raba Léon, France. alexandre.boyer@chu-bordeaux.fr
authors.forename: Alexandre
authors.initials: A
authors.lastname: Boyer
authors.forename: Brice
authors.initials: B
authors.lastname: Amadeo
authors.forename: Frédéric
authors.initials: F
authors.lastname: Vargas
authors.forename: Ma
authors.initials: M
authors.lastname: Yu
authors.forename: Sylvie
authors.initials: S
authors.lastname: Maurice-Tison
authors.forename: Véronique
authors.initials: V
authors.lastname: Dubois
authors.forename: Cécile
authors.initials: C
authors.lastname: Bébéar
authors.forename: Anne Marie
authors.initials: AM
authors.lastname: Rogues
authors.forename: Didier
authors.initials: D
authors.lastname: Gruson
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D001364:Awareness; D017714:Community-Acquired Infections / Q000188:drug therapy / Q000382:microbiology / Q000523:psychology*; D003428:Cross Infection / Q000188:drug therapy / Q000382:microbiology / Q000523:psychology*; D004754:Enterobacter / Q000235:genetics / Q000302:isolation & purification* / Q000502:physiology; D005260:Female; D006760:Hospitalization; D006801:Humans; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D018410:Pneumonia, Bacterial / Q000188:drug therapy / Q000382:microbiology / Q000523:psychology*; D012189:Retrospective Studies; D012720:Severity of Illness Index
chemical_list: D000900:Anti-Bacterial Agents