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Increasing Enterobacter bacteremia in pediatric patients
J Andresen1, B I Asmar, A S Dajani
1Department of Pediatrics, Wayne State University, Detroit, MI.
Abstract:
Thirty-two episodes of Enterobacter bacteremia were identified in 30 patients at Children's Hospital of Michigan between September, 1989, and November, 1992. Fifty-six percent of the episodes were nosocomial. Enterobacter accounted for 14% of all nosocomial bacteremias and was the most common Gram-negative organism causing such infections. Enterobacter cloacae was the most commonly isolated species (72%). Twenty-nine (97%) patients had underlying risk factors for infection, including central venous catheters in 22. The susceptibility pattern of 46 Enterobacter isolates from blood during the same study period showed high resistance to extended spectrum penicillins and third generation cephalosporins but low resistance to aminoglycosides and trimethoprim-sulfamethoxazole (TMP/SMX). Resistance to third generation cephalosporins increased throughout the study period and was higher in patients who had received these agents during the previous month. In situations where there is a high frequency of Gram-negative bacteremias with organisms resistant to third generation cephalosporins, we suggest that initial therapy be a combination of a beta-lactam agent and an aminoglycoside or TMP/SMX.
Insights
Enterobacter bacteremia is a common nosocomial infection, often caused by Enterobacter cloacae. Initial treatment should combine a beta-lactam with aminoglycosides or trimethoprim-sulfamethoxazole due to rising resistance.
Area of Science:
- Medical Microbiology
- Infectious Diseases
- Hospital Epidemiology
Background:
- Enterobacter bacteremia represents a significant nosocomial infection, particularly in pediatric settings.
- Enterobacter species, notably Enterobacter cloacae, are frequent Gram-negative pathogens in hospital-acquired bacteremia.
- Patients often present with underlying risk factors, including central venous catheter use.
Purpose of the Study:
- To analyze the epidemiology and antimicrobial susceptibility patterns of Enterobacter bacteremia.
- To evaluate trends in resistance to commonly used antibiotics, including third-generation cephalosporins.
- To provide evidence-based recommendations for initial antimicrobial therapy.
Main Methods:
- Retrospective analysis of 32 Enterobacter bacteremia episodes in 30 patients from September 1989 to November 1992.
- Identification and species characterization of Enterobacter isolates.
- Antimicrobial susceptibility testing of blood isolates.
Main Results:
- Fifty-six percent of episodes were nosocomial, with Enterobacter accounting for 14% of all Gram-negative nosocomial bacteremias.
- High resistance rates were observed for extended-spectrum penicillins and third-generation cephalosporins.
- Low resistance was noted for aminoglycosides and trimethoprim-sulfamethoxazole (TMP/SMX); resistance to third-generation cephalosporins increased over time.
Conclusions:
- Enterobacter bacteremia is a prevalent nosocomial infection with increasing resistance to third-generation cephalosporins.
- Empirical therapy should consider combination regimens, such as a beta-lactam with an aminoglycoside or TMP/SMX.
- Close monitoring of antimicrobial resistance patterns is crucial for effective patient management.