title: Clinical and Therapeutic Implications of Aeromonas Bacteremia: 14 Years Nation-Wide Experiences in Korea.
abstract: BACKGROUND
  To elucidate the clinical presentation, antimicrobial susceptibility, and prognostic factors of monomicrobial Aeromonas bacteremia in order to determine the most effective optimal therapy.
  
  
  METHODS
  We reviewed the medical records of Aeromonas bacteremia patients for the period January 2000 to December 2013 in a retrospective multi-center study.
  
  
  RESULTS
  A total of 336 patient records were reviewed, with 242 having community-acquired bacteremia. The major clinical infections were of the hepatobiliary tract (50.6%) and peritonitis (18.5%), followed by primary bacteremia (17.9%). The infections usually occurred in patients with malignancy (42.3%), hepatic cirrhosis (39.3%), or diabetes mellitus (25.6%). High antimicrobial-resistance rates (15.5% for ceftriaxone, 15.5% for piperacillin/tazobactam) were noted. However, resistance to carbapenem and amikacin was only 9.8% and 3.0%, respectively. Aeromonas hydrophila (58.9%) was the most common pathogen, followed by Aeromonas caviae (30.4%). The severity of A. caviae bacteremia cases were less than that of A. hydrophila or Aeromonas veronii bacteremia (P <0.05). A. hydrophila showed higher antimicrobial resistance than did other Aeromonas species (P <0.05). Patients with hospital-acquired bacteremia were more likely to have severely abnormal laboratory findings and relatively high antimicrobial-resistance rates. Mortality was associated with metastatic cancer, shock, delayed use of appropriate antimicrobial agents, increased prothrombin time, and increased creatinine level (P <0.05).
  
  
  CONCLUSIONS
  Aeromonas species should be considered one of the causative agents of bacteremia in patients with intra-abdominal infections or malignancies. Although ceftriaxone-resistant Aeromonas bacteremia was not statistically related to mortality in this study, it was associated with severe clinical manifestations and laboratory abnormalities. Appropriate antibiotics, including carbapenem, should be administered early, especially in Aeromonas bacteremia patients with shock and impaired renal function.
authors.affiliation: Division of Infectious Diseases, Department of Medicine, Dankook University Hospital, Cheonan, Korea.
authors.forename: Ji Young
authors.identifier: http://orcid.org/0000-0003-4664-7048
authors.initials: JY
authors.lastname: Rhee
authors.affiliation: Division of Infectious Diseases, Department of Medicine, Dong-A University Hospital, Busan, Korea.
authors.forename: Dong Sik
authors.initials: DS
authors.lastname: Jung
authors.affiliation: Division of Infectious Diseases, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea. krpeck@skku.ac.kr.
authors.forename: Kyong Ran
authors.identifier: http://orcid.org/0000-0002-7464-9780
authors.initials: KR
authors.lastname: Peck
keywords: Aeromonas; Antimicrobial resistance; Bacteremia; Risk factors