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The clinical relevance of Enterobacter infections
1Infectious Diseases Section, Cleveland Department of Veterans Affairs Medical Center, Ohio.
Abstract:
An 18-month prospective study of Enterobacter bacteremia was conducted in 129 patients. The results indicated that (1) emergence of resistance was more frequent during treatment with third-generation cephalosporins than with other antibiotics; (2) the addition of an aminoglycoside to the cephalosporin did not prevent emergence of resistance; (3) previous treatment with cephalosporins was associated with bacteremia caused by multiresistant Enterobacter species; and (4) infection with multiresistant Enterobacter species was associated with a higher mortality than infection with susceptible strains. It is concluded that avoidance of third-generation cephalosporins for surgical prophylaxis and therapy in patients in whom Enterobacter infections are suspected or proven should lower the prevalence of Enterobacter bacteremias and mortality and prevent the emergence of multiresistance.
Insights
Third-generation cephalosporins increase Enterobacter resistance and mortality. Avoiding these antibiotics for suspected infections may reduce resistant Enterobacter bacteremia and associated deaths.
Area of Science:
- Clinical Microbiology
- Infectious Diseases
- Antimicrobial Resistance
Background:
- Enterobacter species are significant nosocomial pathogens.
- Emergence of antimicrobial resistance in Enterobacter complicates treatment.
- Third-generation cephalosporins are commonly used antibiotics.
Purpose of the Study:
- To investigate the relationship between third-generation cephalosporin use and the emergence of resistance in Enterobacter bacteremia.
- To assess the impact of antimicrobial resistance on mortality in Enterobacter bacteremia.
Main Methods:
- Prospective study of 129 patients with Enterobacter bacteremia over 18 months.
- Analysis of antibiotic treatment regimens and patient outcomes.
- Comparison of mortality rates between infections with resistant and susceptible strains.
Main Results:
- Higher rates of resistance emerged with third-generation cephalosporin treatment compared to other antibiotics.
- Aminoglycoside addition to cephalosporins did not prevent resistance.
- Prior cephalosporin use was linked to multiresistant Enterobacter infections.
- Multiresistant Enterobacter infections had higher mortality.
Conclusions:
- Avoidance of third-generation cephalosporins for prophylaxis and treatment in suspected Enterobacter infections is recommended.
- Reducing third-generation cephalosporin use may lower Enterobacter bacteremia prevalence and mortality.
- This strategy could prevent the emergence of multidrug resistance in Enterobacter species.