title: Risk factor analysis for extended-spectrum β-lactamase-producing Enterobacter cloacae bloodstream infections in central Taiwan.
abstract: BACKGROUND
  Enterobacter cloacae (E.cloacae) bloodstream infection (EcBSI) is an important cause of morbidity and mortality, with an increasing incidence in our hospital. We wanted to elucidate the risk factors of mortality among patients with ESBL-positive EcBSI in central Taiwan.
  
  
  METHODS
  We ordered the clinical and microbiological data of cases with diagnosis of EcBSI, and analyzed the isolates by using antibiotyping, detection of ESBL, detection of class 1 integron and genomic fingerprinting by pulsed-field gel electrophoresis (PFGE).
  
  
  RESULTS
  Seventy episodes of EcBSI from 70 patients (56 hospital-acquired infections) were enrolled. Significant differences were found between ESBL-positive and ESBL-negative isolates with regard to risk factors, including the diseases severity (p = 0.03), category of health care-associated infection (p = 0.04), prior use of antibiotics (p = 0.023), and prior use of a ventilator (p = 0.037). A significant difference in mortality between two groups (p = 0.004) was determined using the chi-square test, and a trend in mortality between two groups (p = 0.006, OR = 4.750, 95% C.I.=1.573-14.344) was determined using univariate logistic regression analysis. The predominant clone in ESBL-positive strains was associated with a higher mortality rate but not with the presence of the integron.
  
  
  CONCLUSIONS
  The study disclosed four types of clinical characteristics to obtain ESBL-positive EcBSI, and there was a trend in mortality too. We suggested the need to review antibiotic prescription practices, and the possible need to consider ESBL-positive strains in empirical treatment of bloodstream infection.
authors.affiliation: College of Life Science, National Chung Hsing University, No, 250 Kuo-Kuang Road, Taichung 40227, Taiwan. cchuang@dragon.nchu.edu.tw.
authors.forename: Chang-Hua
authors.initials: CH
authors.lastname: Chen
authors.forename: Chieh-Chen
authors.initials: CC
authors.lastname: Huang
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000494:pharmacology; D016470:Bacteremia / Q000453:epidemiology / Q000382:microbiology*; D002648:Child; D002675:Child, Preschool; D003428:Cross Infection / Q000453:epidemiology / Q000382:microbiology; D016972:Enterobacter cloacae / Q000187:drug effects / Q000201:enzymology* / Q000235:genetics / Q000302:isolation & purification*; D004756:Enterobacteriaceae Infections / Q000453:epidemiology / Q000382:microbiology*; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D008826:Microbial Sensitivity Tests; D008875:Middle Aged; D012307:Risk Factors; D013624:Taiwan / Q000453:epidemiology; D055815:Young Adult; D001618:beta-Lactamases / Q000235:genetics* / Q000378:metabolism
chemical_list: D000900:Anti-Bacterial Agents; D001618:beta-Lactamases