Enterobacter Bacteremia â€“ A Retrospective Study In A Teaching Hospital

Dr Deepthi Nair; Dr Khaleefa Al Benwan; Dr Wehad Hamad Altourah

Volume : V, Issue : VIII, August - 2016

Enterobacter Bacteremia â€“ A Retrospective Study In A Teaching Hospital

Dr Deepthi Nair, Dr Khaleefa Al Benwan, Dr Wehad Hamad Altourah

Abstract :

 Objective: To evaluate the microbiological, clinical and therapeutic factors associated with bacteremia caused by Enterobacter species. Methods: One hundred and twenty–seven cases of bacteremia caused by Enterobacter species over a period of ten years from January 2006– December 2015 in a teaching hospital in Kuwait were enrolled in a retrospective study. Organisms detected by blood culture (BACTEC) were identified by commercial identification systems (API 20E, Vitek 2). Antimicrobial susceptibility was determined by disc diffusion method and Vitek 2. Medical records of the cases were reviewed to study the clinical and therapeutic factors related to the bacteremia. Results: Enterobacter bacteremia accounted for 1.78% of all bacteremias during this period of study, E. cloacae being the leading species (84.25%). The incidence rate in 2006 was 1.19/1000 bacteremic cases ,and 1.88/1000 cases in 2015. One hundred and ten (86.61%) cases were hospital acquired. Underlying diseases were detected in 92.12%, the most common being renal disease (59.09%). The most common source of bacteremia was the intravascular catheter (50.39%). Antimicrobial resistance was as follows: third generation cephalosporins 29.92%. ESBL producers were 16.53%. AmpC beta lactamase production was observed in 89.76% of the isolates. Resistance to cefepime , piperacillin –tazobactam, trimethoprim sulfamethoxazole and cefoxitin was 16.53% , 16.53% , 7% and 89.76% respectively. All were sensitive to carbapenems, aminoglycosides and ciprofloxacin except for one strain that was resistant to carbapenems. The response to therapy was 90.55%. Conclusions: Enterobacter bacteremia is mostly nosocomial in origin. Intravascular device related bacteremia is a significant clinical problem. AmpC beta lactamase production is a major factor in deciding antimicrobial therapy in Enterobacter bacteremia. In serious infections, carbapenems, ciprofloxacin and aminoglycosides may be the antibiotics of choice with colistin being the only choice if the strain is multidrug resistant.