Characterization of Enterobacter cloacae pneumonia: a single-center retrospective analysis.
OBJECTIVE
Enterobacter cloacae (E. cloacae) is a Gram-negative rod commonly found on intensive care units (ICU) causing severe infections with high mortality. Specific characteristics of E. cloacae pneumonia, however, have not been identified.


METHODS
Evaluation of clinical and microbiological records of patients with positive respiratory samples for E. cloacae was performed by a 1-year retrospective study in a large university hospital.


RESULTS
Ninety-seven of 115 eligible patients with E. cloacae-positive respiratory samples developed pneumonia. Patients were predominantly male (68%), older (median age = 62 years), and immunodeficient (54%). Seventy-eight percent required ICU admission, of which 97% required mechanical ventilation. Ventilator-associated pneumonia (VAP) occurred in 58%. Those who developed E. cloacae VAP had undergone twice as many surgical procedures under translaryngeal intubation prior to VAP onset (89 vs. 48%, P < 0.0001). Overall, E. cloacae VAP mortality was 24%. In E. cloacae VAP patients, presence of translaryngeal tubes (P = 0.02) and female gender (P = 0.0003) were associated with poor survival. Multivariate analysis confirmed male sex as a protective factor (relative risk: 0.39; P = 0.007).


CONCLUSIONS
Enterobacter cloacae causes VAP with high mortality, predominantly in women. Risk factors for E. cloacae pneumonia seem to match those for VAP. The presence of translaryngeal endotracheal tubes seems to be the specific factor for E. cloacae VAP.
Department of Internal Medicine II-Oncology, Haematology, BMT with Section Pneumology, University Medical Centre Hamburg-Eppendorf, 20246, Hamburg, Germany.
Jan K
JK
Hennigs
Hans Jörg
HJ
Baumann
Stefan
S
Schmiedel
Pierre
P
Tennstedt
Ingo
I
Sobottka
Carsten
C
Bokemeyer
Stefan
S
Kluge
Hans
H
Klose
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016972:Enterobacter cloacae / Q000302:isolation & purification; D004756:Enterobacteriaceae Infections / Q000453:epidemiology* / Q000401:mortality*; D005260:Female; D006801:Humans; D015994:Incidence; D007362:Intensive Care Units; D053208:Kaplan-Meier Estimate; D008168:Lung / Q000382:microbiology; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D018410:Pneumonia, Bacterial / Q000453:epidemiology* / Q000401:mortality*; D053717:Pneumonia, Ventilator-Associated / Q000453:epidemiology* / Q000401:mortality*; D012189:Retrospective Studies; D012307:Risk Factors; D012727:Sex Characteristics; D055815:Young Adult