A prospective, multicenter case control study of risk factors for acquisition and mortality in Enterobacter species bacteremia

Álvarez‐Marín, Rocío; Navarro-Amuedo, Dolores; Gasch-Blasi, Oriol; Rodríguez-Martínez, José Manuel; Calvo-Montes, Jorge; Lara-Contreras, Rosario; Lepe, José Antonio; Tubau-Quintano, Fe; Cano-García, María Eliecer; Rodríguez-López, Fernando; Pujol-Rojo, Miquel; Torre‐Cisneros, Julián; Martı́nez-Martı́nez, Luis; Pascual-Hernández, Álvaro; Me, Jiménez-Mejías

doi:10.1016/j.jinf.2019.09.017

Cited by 20 publications

(7 citation statements)

References 36 publications

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“…Hemodialysis dependence was the only identified risk factor for Ecc BSI. Though no prior studies have addressed the risk factors for BSI with K. aerogenes (or Enterobacter aerogenes, as it was previously named) versus Ecc BSI, a large recent study did find that hemodialysis dependence was an independent risk factor for Enterobacter species BSI relative to noninfected control patients (23).…”

Section: Discussionmentioning

confidence: 99%

Newly Named Klebsiella aerogenes (formerly Enterobacter aerogenes) Is Associated with Poor Clinical Outcomes Relative to Other Enterobacter Species in Patients with Bloodstream Infection

et al. 2020

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Objectives: Enterobacter aerogenes was recently renamed Klebsiella aerogenes. This study aimed to identify differences in clinical characteristics, outcomes, and bacterial genetics among patients with K. aerogenes versus Enterobacter species bloodstream infections (BSI). Methods: We prospectively enrolled patients with K. aerogenes or Enterobacter cloacae complex (Ecc) BSI from 2002-2015. We performed whole genome sequencing (WGS) and pan-genome analysis on all bacteria. Results: Overall, 150 patients with K. aerogenes (46/150 [31%]) or Ecc (104/150 [69%]) BSI were enrolled. The two groups had similar baseline characteristics. Neither total in-hospital mortality (13/46 [28%] versus 22/104 [21%]; p=0.3) nor attributable in-hospital mortality (9/46 [20%] versus 13/104 [12%]; p=0.3) differed between patients with K. aerogenes versus Ecc BSI, respectively. However, poor clinical outcome (death before discharge, recurrent BSI, and/or BSI complication) was higher for K. aerogenes than Ecc BSI (32/46 [70%] versus 42/104 [40%]; p=0.001). In a multivariable regression model, K. aerogenes BSI, relative to Ecc BSI, was predictive of poor clinical outcome (odds ratio 3.3; 95% confidence interval 1.4-8.1; p=0.008). Pan-genome analysis revealed 983 genes in 323 genomic islands unique to K. aerogenes isolates, including putative virulence genes involved in iron acquisition (n=67), fimbriae/pili/flagella production (n=117), and metal homeostasis (n=34). Antibiotic resistance was largely found in Ecc lineage 1, which had a higher rate of multidrug resistant phenotype (23/54 [43%]) relative to all other bacterial isolates (23/96 [24%]; p=0.03). Conclusions: K. aerogenes BSI was associated with poor clinical outcomes relative to Ecc BSI. Putative virulence factors in K. aerogenes may account for these differences.

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Section: Discussionmentioning

confidence: 99%

Newly Named Klebsiella aerogenes (formerly Enterobacter aerogenes) Is Associated with Poor Clinical Outcomes Relative to Other Enterobacter Species in Patients with Bloodstream Infection

et al. 2020

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“…Appropriate empirical treatment was defined as prescription of one or more antimicrobial active against the isolate of ABC, in accordance with the standard antimicrobial susceptibility study, in the first 24 h from the onset of the bacteremia and before its diagnosis, with an approved route and dosage appropriate for end organ function. Appropriate definitive treatment was antibiotic active against the isolate of ABC within 24 h after obtaining the antibiogram, with an approved route and dosage appropriate for end organ function ( 2 ). Adequate source control was defined as removal of any pre-existing devices thought to be the source of BSI or documented interventions using appropriate decompression, debridement, drainage, and other surgical procedures to control the infection source within 48 h of the onset of BSI ( 23 ).…”

Section: Methodsmentioning

confidence: 99%

“…Bloodstream infections (BSIs) are frequent and life-threatening in hospitals ( 1 ). Patients in intensive care units (ICUs) are particularly pre-disposed to BSIs ( 2 ), with a prevalence of ~15% ( 3 ). The Acinetobacter baumannii complex (ABC) has great potential for nosocomial spread ( 4 ).…”

Section: Introductionmentioning

confidence: 99%

Ten-Year Changes in Bloodstream Infection With Acinetobacter Baumannii Complex in Intensive Care Units in Eastern China: A Retrospective Cohort Study

Meng

Zheng

et al. 2021

Front. Med.

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Background: There is little evidence on the changing prevalence, microbiological profile, and outcome of nosocomial Acinetobacter baumannii complex (ABC)-caused bloodstream infection (ABCBSI) specified in intensive care units (ICUs) in long-term studies, especially in China.Objective: We aimed to investigate changes in incidence, antibiotic resistance, therapy, and prognosis of ABCBSI in ICUs in eastern China during 2009–2018.Methods: A multicenter retrospective cohort study was conducted, and microbiological and clinical data for patients with ABCBSI acquired in nine adult ICUs in eastern China from 2009 to 2018.Results: A total of 202 cases were enrolled. For the years 2009–2010, 2011–2012, 2013–2014, 2015–2016, and 2017–2018, the incidence of ABCBSI increased significantly, as did the percentage of pan-drug-resistant isolates and resistant rates to most of antimicrobial agents; the percentage of drug-sensitive isolates decreased (all P < 0.05). The frequency of treatment with carbapenems and tigecycline increased, and that of cephalosporins decreased. Compared with those in the first years (2009–2012), ABCBSI patients in the lattermost years (2017–2018) were less often treated with appropriate empirical therapy, more often underwent pneumonia-related ABCBSI and mechanical ventilation support, and had higher 28-day mortality rates. Multivariate Cox regression indicated that increase in the degree of ABC antibiotics resistance, pneumonia-related ABCBSI, and septic shock were risk factors of 28-day mortality and associated with significant lower survival days.Conclusions: The past decade has witnessed a marked increase in the incidence of ABCBSI and in antibiotic resistance, with increasing pneumonia-related infections and worrisome mortality in ICUs in China. Controlling increasing resistance and preventing nosocomial pneumonia may play important roles in combatting these infections.

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“…However, we could not identify any other article that reported the mortality rate for patients with polymyxin-resistant K. aerogenes . Some studies have evaluated patients with carbapenem-resistant K. aerogenes infection and reported mortality rates of 20% [ 23 ], 37.5% [ 24 ], and 40.3% [ 25 ] for patients with severe sepsis. These results reinforced the criticality of infection control measures to prevent the spread of such bacteria in hospitals.…”

Section: Resultsmentioning

confidence: 99%

Genetic Diversity of Virulent Polymyxin-Resistant Klebsiella aerogenes Isolated from Intensive Care Units

et al. 2022

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This study evaluated the scope and genetic basis of polymyxin-resistant Klebsiella aerogenes in Brazil. Eight polymyxin-resistant and carbapenemase-producing K. aerogenes strains were isolated from patients admitted to the ICU of a tertiary hospital. Bacterial species were identified by automated systems and antimicrobial susceptibility profile was confirmed using broth microdilution. The strains displayed a multidrug resistant profile and were subjected to whole-genome sequencing. Bioinformatic analysis revealed a variety of antimicrobial resistance genes, including the blaKPC-2. No plasmid-mediated colistin resistance gene was identified. Nonetheless, nonsynonymous mutations in mgrB, pmrA, pmrB, and eptA were detected, justifying the colistin resistance phenotype. Virulence genes encoding yersiniabactin, colibactin, and aerobactin were also found, associated with ICEKp4 and ICEKp10, and might be related to the high mortality observed among the patients. In fact, this is the first time ICEKp is identified in K. aerogenes in Brazil. Phylogenetic analysis grouped the strains into two clonal groups, belonging to ST93 and ST16. In summary, the co-existence of antimicrobial resistance and virulence factors is deeply worrying, as it could lead to the emergence of untreatable invasive infections. All these factors reinforce the need for surveillance programs to monitor the evolution and dissemination of multidrug resistant and virulent strains among critically ill patients.

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A prospective, multicenter case control study of risk factors for acquisition and mortality in Enterobacter species bacteremia

Cited by 20 publications

References 36 publications

Newly Named Klebsiella aerogenes (formerly Enterobacter aerogenes) Is Associated with Poor Clinical Outcomes Relative to Other Enterobacter Species in Patients with Bloodstream Infection

Newly Named Klebsiella aerogenes (formerly Enterobacter aerogenes) Is Associated with Poor Clinical Outcomes Relative to Other Enterobacter Species in Patients with Bloodstream Infection

Ten-Year Changes in Bloodstream Infection With Acinetobacter Baumannii Complex in Intensive Care Units in Eastern China: A Retrospective Cohort Study

Genetic Diversity of Virulent Polymyxin-Resistant Klebsiella aerogenes Isolated from Intensive Care Units

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