Treatment outcomes in patients with third-generation cephalosporin-resistant Enterobacter bacteremia.
BACKGROUND
Infections with resistant Enterobacter spp. are increasingly described, yet data on outcomes associated with these infections are limited.


METHODS
A retrospective cohort study was conducted to investigate outcomes of hospitalized patients with third-generation cephalosporin-resistant (CR) Enterobacter bacteremia. Cephalosporin resistance was detected using cefotaxime and cefpodoxime. Patients with Enterobacter spp. bacteremia from January 2006 through February 2008 defined the population. We defined cases as those with CR isolates; controls were patients with bacteremia due to non-CR isolates. Treatment failure was defined as persistence of the presenting signs of infection 72 h after initial culture collection.


RESULTS
Of the 95 Enterobacter cases identified, 31 (33%) were CR. CR cases were significantly associated with treatment failure (odds ratio (OR) 2.81, 95% confidence interval (CI) 1.14-6.94). This association was not seen after adjustment for age, simplified acute physiology score (SAPS II), and inappropriate empiric antibiotic therapy. Inappropriate empiric therapy (adjusted OR 3.86, 95% CI 1.32-11.31) and SAPS II score (adjusted OR 1.09, 95% CI 1.02-1.16) were significantly associated with treatment failure in the multivariate analysis.


CONCLUSIONS
Third-generation cephalosporin-resistant Enterobacter bacteremia is associated with treatment failure due to receipt of inappropriate empiric antibiotic therapy and severity of illness.
Department of Medicine, Louisiana State University Health Sciences Center, Baton Rouge, Louisiana 70805, USA. coneal@lsuhsc.edu
Catherine S
CS
O'Neal
Hollis R
HR
O'Neal
Titus L
TL
Daniels
Thomas R
TR
Talbot
D000900:Anti-Bacterial Agents / Q000494:pharmacology / Q000627:therapeutic use*; D016470:Bacteremia / Q000188:drug therapy* / Q000382:microbiology; D002511:Cephalosporins / Q000494:pharmacology / Q000627:therapeutic use*; D015331:Cohort Studies; D004754:Enterobacter / Q000187:drug effects* / Q000302:isolation & purification; D004756:Enterobacteriaceae Infections / Q000188:drug therapy* / Q000382:microbiology; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D017211:Treatment Failure; D018440:beta-Lactam Resistance
D000900:Anti-Bacterial Agents; D002511:Cephalosporins