Joseph W. Chow, MD; Michael J. Fine, MD; David M. Shlaes, MD, PhD; John P. Quinn, MD; David C. Hooper, MD; Michaekl P. Johnson, MD; Reuben Ramphal, MD; Marilyn M. Wagener, MS; Deborah K. Miyashiro, MS; Victor L. Yu, MD
▪Objectives: To study the effect of previously administered antibiotics on the antibiotic susceptibility profile of Enterobacter, the factors affecting mortality, and the emergence of antibiotic resistance during therapy for Enterobacter bacteremia.
▪Design: Prospective, observational study of consecutive patients with Enterobacter bacteremia.
▪Setting: Three university tertiary care centers, one major university-affiliated hospital, and two university-affiliated Veterans Affairs medical centers.
▪Patients: A total of 129 adult patients were studied.
▪Measurements: The two main end points were emergence of resistance during antibiotic therapy and death.
▪Main Results: Previous administration of third-generation cephalosporins was more likely to be associated with multiresistant Enterobacter isolates in an initial, positive blood culture (22 of 32, 69%) than was administration of antibiotics that did not include a third-generation cephalosporin (14 of 71, 20%; P < 0.001). Isolation of multiresistant Enterobacter sp. in the initial blood culture was associated with a higher mortality rate (12 of 37, 32%) than was isolation of a more sensitive Enterobacter sp. (14 of 92, 15%; P = 0.03). Emergence of resistance to third-generation cephalosporin therapy (6 of 31, 19%) occurred more often than did emergence of resistance to aminoglycoside (1 of 89, 0.01%; P = 0.001) or other beta-lactam (0 of 50; P = 0.002) therapy.
▪Conclusions: More judicious use of third-generation cephalosporins may decrease the incidence of nosocomial multiresistant Enterobacter spp., which in turn may result in a lower mortality for Enterobacter bacteremia. When Enterobacter organisms are isolated from blood, it may be prudent to avoid third-generation cephalosporin therapy regardless of in-vitro susceptibility.
Chow JW, Fine MJ, Shlaes DM, Quinn JP, Hooper DC, Johnson MP, et al. Enterobacter Bacteremia: Clinical Features and Emergence of Antibiotic Resistance during Therapy. Ann Intern Med. ;115:585–590. doi: 10.7326/0003-4819-115-8-585
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Published: Ann Intern Med. 1991;115(8):585-590.
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