The full content of Annals is available to subscribers

Subscribe/Learn More  >
Articles |

Enterobacter Bacteremia: Clinical Features and Emergence of Antibiotic Resistance during Therapy

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; and Victor L. Yu, MD
[+] Article and Author Information

Grant Support: Dr. Chow was partly supported by NIH training grant 5T32AI07333.

Requests for Reprints: Victor L. Yu, MD, University of Pittsburgh School of Medicine, 968 Scaife, Pittsburgh, PA 15261.

Current Author Addresses: Dr. Chow: Division of Infectious Diseases, Harper Hospital, 3990 John R Street, Detroit, MI 48201.

Dr. Fine: Department of Internal Medicine, University of Pittsburgh School of Medicine, 167 Lothrop Hall, Pittsburgh, PA 15261.

Dr. Shlaes: Infectious Diseases Section, Veterans Affairs Medical Center, 10701 East Boulevard, Cleveland, OH 44106.

Dr. Quinn and Ms. Miyashiro: Division of Infectious Diseases, Michael Reese Hospital, Lake Shore Drive at 31st Street, Chicago, IL 60616.

Dr. Hooper: Massachusetts General Hospital, Infectious Disease Unit, Department of Medicine, Fruit Street, Boston, MA 02114.

Dr. Johnson: Division of Disease Control, Johns Hopkins School of Hygiene and Health, 615 North Wolfe Street, Baltimore, MD 21205.

Dr. Ramphal: Division of Infectious Diseases, Box J-277, JHMHC, University of Florida, Gainesville, FL 32610.

Ms. Wagener and Dr. Yu: Infectious Disease Section, Veterans Affairs Medical Center, University Drive C, Pittsburgh, PA 15240.

Ann Intern Med. 1991;115(8):585-590. doi:10.7326/0003-4819-115-8-585
Text Size: A A A

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.





Citing articles are presented as examples only. In non-demo SCM6 implementation, integration with CrossRef’s "Cited By" API will populate this tab (http://www.crossref.org/citedby.html).


Submit a Comment
Submit a Comment

Summary for Patients

Clinical Slide Sets

Terms of Use

The In the Clinic® slide sets are owned and copyrighted by the American College of Physicians (ACP). All text, graphics, trademarks, and other intellectual property incorporated into the slide sets remain the sole and exclusive property of the ACP. The slide sets may be used only by the person who downloads or purchases them and only for the purpose of presenting them during not-for-profit educational activities. Users may incorporate the entire slide set or selected individual slides into their own teaching presentations but may not alter the content of the slides in any way or remove the ACP copyright notice. Users may make print copies for use as hand-outs for the audience the user is personally addressing but may not otherwise reproduce or distribute the slides by any means or media, including but not limited to sending them as e-mail attachments, posting them on Internet or Intranet sites, publishing them in meeting proceedings, or making them available for sale or distribution in any unauthorized form, without the express written permission of the ACP. Unauthorized use of the In the Clinic slide sets will constitute copyright infringement.


Buy Now

to gain full access to the content and tools.

Want to Subscribe?

Learn more about subscription options

Related Articles
Journal Club
Related Point of Care
Topic Collections
PubMed Articles
Forgot your password?
Enter your username and email address. We'll send you a reminder to the email address on record.