Bacteremia in Hematopoietic Stem Cell Recipients Receiving Fluoroquinolone Prophylaxis: Incidence, Resistance, and Risk Factors

Eryilmaz-Eren Esma,Izci Feyza,Ture Zeynep,Sagiroglu Pinar,Kaynar Leylagul,Ulu-Kilic Aysegul 대한감염학회 2022 Infection and Chemotherapy Vol.54 No.3

Background Bacteremia is a common complication in hematopoietic stem cell transplant (HSCT) recipients. Prophylactic fluoroquinolone is recommended and used in these individuals. Breakthrough infections can occur with fluoroquinolone-resistant strains. We aimed to identify the incidence, resistance, and risk factors for bacteremia in HSCT recipients receiving fluoroquinolone prophylaxis. Materials and Methods This retrospective study was performed on patients who received fluoroquinolone prophylaxis and underwent autologous and allogeneic HSCT between 2015 and 2019. The incidence of bacteremia, comorbidity, treatment, and invasive procedures was compared in these patients with and without bacteremia. Results There were 553 patients included in the study, 68 (12.3%) had bacteremia. The incidence of bacteremia is 8.2% of autologous HSCT recipients and 18.4% of allogeneic HSCT recipients. The significant risk factors associated with bacteremia were steroid-using (odds ratio [OR]:13.83, 95% confidence interval [CI]: 2.88 - 66.40), higher Charlson Comorbidity Index (CCI)-mean (OR: 1.57, 95% CI: 1.15 - 2.16), diabetes mellitus (OR: 4.29, 95% CI: 1.11 - 16.48) in autologous HSCT, steroid-using (OR: 6.84, 95% CI: 1.44 - 32.33), longer duration of neutropenia (OR: 1.05, 95% CI: 1.01 - 1.09) using central venous catheter (OR: 7.81, 95% CI: 1.00 - 61.23) in allogeneic HSCT. Seventy-three pathogens were isolated from a total of 68 bacteremia episodes. The most commonly occurring agents were Escherichia coli, Klebsiella pneumoniae and Enterococcus spp. Resistance to fluoroquinolones was 87.2%, 70.0% and 60.0% among these strains, respectively. Conclusion High CCI, diabetes mellitus, use of steroids and long-term neutropenia and use of central venous catheters were significantly associated with the breakthrough bacteremia in HSCT recipients receiving fluoroquinolone prophylaxis. Fluoroquinolone prophylaxis may reduce the incidence of bacteremia but may select strains resistant to fluoroquinolone. Background Bacteremia is a common complication in hematopoietic stem cell transplant (HSCT) recipients. Prophylactic fluoroquinolone is recommended and used in these individuals. Breakthrough infections can occur with fluoroquinolone-resistant strains. We aimed to identify the incidence, resistance, and risk factors for bacteremia in HSCT recipients receiving fluoroquinolone prophylaxis. Materials and Methods This retrospective study was performed on patients who received fluoroquinolone prophylaxis and underwent autologous and allogeneic HSCT between 2015 and 2019. The incidence of bacteremia, comorbidity, treatment, and invasive procedures was compared in these patients with and without bacteremia. Results There were 553 patients included in the study, 68 (12.3%) had bacteremia. The incidence of bacteremia is 8.2% of autologous HSCT recipients and 18.4% of allogeneic HSCT recipients. The significant risk factors associated with bacteremia were steroid-using (odds ratio [OR]:13.83, 95% confidence interval [CI]: 2.88 - 66.40), higher Charlson Comorbidity Index (CCI)-mean (OR: 1.57, 95% CI: 1.15 - 2.16), diabetes mellitus (OR: 4.29, 95% CI: 1.11 - 16.48) in autologous HSCT, steroid-using (OR: 6.84, 95% CI: 1.44 - 32.33), longer duration of neutropenia (OR: 1.05, 95% CI: 1.01 - 1.09) using central venous catheter (OR: 7.81, 95% CI: 1.00 - 61.23) in allogeneic HSCT. Seventy-three pathogens were isolated from a total of 68 bacteremia episodes. The most commonly occurring agents were Escherichia coli, Klebsiella pneumoniae and Enterococcus spp. Resistance to fluoroquinolones was 87.2%, 70.0% and 60.0% among these strains, respectively. Conclusion High CCI, diabetes mellitus, use of steroids and long-term neutropenia and use of central venous catheters were significantly associated with the breakthrough bacteremia in HSCT recipients receiving fluoroquinolone prophylaxis. Fluoroquinolone prophylaxis may reduce the incidence of bacteremia but may select strains resistant to fluoroquinolone.

Clinical and microbiological features of Providencia bacteremia: experience at a tertiary care hospital

( Hee Kyoung Choi ),( Young Keun Kim ),( Hyo Youl Kim ),( Jeong Eun Park ),( Young Uh ) 대한내과학회 2015 The Korean Journal of Internal Medicine Vol.30 No.2

Background/Aims: Providencia species frequently colonize urinary catheters and cause urinary tract infections (UTIs); however, bacteremia is uncommon and not well understood. We investigated the clinical features of Providencia bacteremia and the antibiotic susceptibility of Providencia species. Methods: We identified cases of Providencia bacteremia from May 2001 to April 2013 at a tertiary care hospital. The medical records of pertinent patients were reviewed. Results: Fourteen cases of Providencia bacteremia occurred; the incidence rate was 0.41 per 10,000 admissions. The median age of the patients was 64.5 years. Eleven cases (78.6%) were nosocomial infections and nine cases (64.3%) were polymicrobial bacteremia. The most common underlying conditions were cerebrovascular/neurologic disease (n = 10) and an indwelling urinary catheter (n = 10, 71.4%). A UTI was the most common source of bacteremia (n = 5, 35.7%). The overall mortality rate was 29% (n = 4); in each case, death occurred within 4 days of the onset of bacteremia. Primary bacteremia was more fatal than other types of bacteremia (mortality rate, 75% [3/4] vs. 10% [1/10], p = 0.041). The underlying disease severity, Acute Physiologic and Chronic Health Evaluation II scores, and Pitt bacteremia scores were significantly higher in nonsurvivors ( p = 0.016, p =0.004, and p = 0.002, respectively). Susceptibility to cefepime, imipenem, and piperacillin/tazobactam was noted in 100%, 86%, and 86% of the isolates, respectively. Conclusions: Providencia bacteremia occurred frequently in elderly patients with cerebrovascular or neurologic disease. Although Providencia bacteremia is uncommon, it can be rapidly fatal and polymicrobial. These characteristics suggest that the selection of appropriate antibiotic therapy could be complicated in Providencia bacteremia.

최근 임상검체에서의 혐기성 세균 분리 현황 및 혐기성 균혈증의 임상적 특징

박용정,김명숙,최준용,용동은,정석훈,김준명,정윤섭,이경원,이양순 대한감염학회 2009 Infection and Chemotherapy Vol.41 No.4

Background:Anaerobic bacteria can cause various infections, and their incidence may differ greatly, depending on the country or hospital. We investigated recent trends in anaerobe isolation and clinical characteristics of anaerobic bacteremia in one hospital in Korea to facilitate diagnosis and treatment of anaerobic infections. Materials and Methods:Anaerobic bacteria isolated from blood, body fluids and abscess specimens at a university hospital in Korea during 2007 and 2008 were analyzed. The medical records of 82 anaerobic bacteremia patients were reviewed. A retrospective cohort study was conducted to determine the risk factors for in-hospital mortality of patients with anaerobic bacteremia. Results:A total of 289 non-duplicated anaerobic isolates were recovered from blood, body fluids and abscess specimens. Bacteroides fragilis (73 isolates, 25.3%) was the most common organism followed by Clostridium perfringens (22 isolates, 7.6%), Peptoniphilus asaccharolyticus (21 isolates, 7.3%) and Anaerococcus prevotii (19 isolates, 6.6%). Eighty-four isolates were recovered from blood specimens, among which B. fragilis (24 isolates) and C. perfringens (21 isolates) were the most frequently isolated organisms. Among the 196 underlying diseases of anaerobic bacteremia patients, neoplastic, infectious, and gastrointestinal diseases accounted for 54 (27.6%), 46 (23.5%), and 41 (20.9%) cases, respectively. The alimentary tract was the most common suspected portal of entry. The in-hospital mortality rate of anaerobic bacteremia patients was 34.2%, and neutropenia at the time of blood culture was the only statistically significant factor associated with mortality in this study. Anaerobes were isolated in 1.4% of all positive blood cultures. Conclusions:B. fragilis and C. perfringens are expected to be commonly isolated from clinical specimens. Despite its low prevalence, anaerobic bacteremia displays a significant in-hospital mortality rate. Ongoing investigations into anaerobic bacteremia are necessary because of ambiguous risk factors for mortality. Background:Anaerobic bacteria can cause various infections, and their incidence may differ greatly, depending on the country or hospital. We investigated recent trends in anaerobe isolation and clinical characteristics of anaerobic bacteremia in one hospital in Korea to facilitate diagnosis and treatment of anaerobic infections. Materials and Methods:Anaerobic bacteria isolated from blood, body fluids and abscess specimens at a university hospital in Korea during 2007 and 2008 were analyzed. The medical records of 82 anaerobic bacteremia patients were reviewed. A retrospective cohort study was conducted to determine the risk factors for in-hospital mortality of patients with anaerobic bacteremia. Results:A total of 289 non-duplicated anaerobic isolates were recovered from blood, body fluids and abscess specimens. Bacteroides fragilis (73 isolates, 25.3%) was the most common organism followed by Clostridium perfringens (22 isolates, 7.6%), Peptoniphilus asaccharolyticus (21 isolates, 7.3%) and Anaerococcus prevotii (19 isolates, 6.6%). Eighty-four isolates were recovered from blood specimens, among which B. fragilis (24 isolates) and C. perfringens (21 isolates) were the most frequently isolated organisms. Among the 196 underlying diseases of anaerobic bacteremia patients, neoplastic, infectious, and gastrointestinal diseases accounted for 54 (27.6%), 46 (23.5%), and 41 (20.9%) cases, respectively. The alimentary tract was the most common suspected portal of entry. The in-hospital mortality rate of anaerobic bacteremia patients was 34.2%, and neutropenia at the time of blood culture was the only statistically significant factor associated with mortality in this study. Anaerobes were isolated in 1.4% of all positive blood cultures. Conclusions:B. fragilis and C. perfringens are expected to be commonly isolated from clinical specimens. Despite its low prevalence, anaerobic bacteremia displays a significant in-hospital mortality rate. Ongoing investigations into anaerobic bacteremia are necessary because of ambiguous risk factors for mortality.

지역사회 발생 폐렴막대균 균혈증에서 의료관련감염의 임상적, 미 생물학적 특성

이정아,강철인,주은정,하영은,박소연,정두련,백경란,이남용,송재훈 대한감염학회 2012 Infection and Chemotherapy Vol.44 No.2

Background: Although healthcare-associated (HCA) Klebsiella pneumoniae bacteremia constitutes a significant proportion of community-onset infection cases, its clinical and microbiologic characteristics have yet to be described in detail. In this study, we sought to delineate the clinical differences between community-associated (CA) and HCA K. pneumoniae bacteremia. Materials and methods: A total of 240 patients infected by community-onset K. pneumoniae bacteremia were included in this study, and the data from the patients with HCA K. pneumoniae bacteremia were compared to those with the CA bacteremia. Isolates were microbiologically characterized and serotyped using a PCR method. Results: Of the total 240 patients infected with community-onset K. pneumoniae bacteremia,140 (58.3%) were defined as HCA infection cases, and the remaining 100 patients were classified as CA infections. Multivariate analysis showed that use of percutaneous tubes, occurrence of a recent surgical operation, cases of pneumonia,neutropenia and solid tumor, and prior receipt of antibiotics were all significant factors associated with HCA bacteremia infection (all P<0.05). In terms of microbiologic characteristics, ciprofloxacin resistance (12.9% [18/140] vs. 4.0% [4/100], P=0.02) and extended-spectrum β-lactamase production (12.1% [17/140] vs. 4.0% [4/100], P =0.03)were more common in HCA bacteremia than CA bacteremia, respectively. The K1 and K2 serotypes, which are considered virulent community strains, were observed to exist more frequently in CA bacteremia than in HCA bacteremia (34% [34/100] vs. 21.4%[30/140], P=0.03). The overall 30-day mortality of the study population was 17.5%(37/211), and there was a trend toward greater mortality in the HCA group than in the CA group (21.4% [27/126] vs. 11.8% [10/85]; P=0.07). Conclusions: Patients infected with HCA bacteremia accounted for a substantial proportion of all patients with community-onset K. pneumoniae bacteremia, and showed significantly different clinical and microbiological characteristics than those infected with CA bacteremia. HCA K. pneumoniae bacteremia represented a distinct subset of community-onset bacteremia characterized by antibiotic resistant pathogens, a finding which physicians should consider in providing optimal treatment of these cases.

황색포도구균혈증의 임상적 고찰

홍화정(Hwa Jeong Hong),이정환(Chung Hwan Lee),박종오(Chong Oh Park),정일우(Il Woo Jung),이승호(Seung Ho Lee),고경식(Kyung Sik Ko),김구엽(Koo Yeop Kim),서환조(Hwan Jo Suh) 대한내과학회 1997 대한내과학회지 Vol.53 No.3

N/A Objective: Staphylococcus aureus has persisted and is now resurging as an important hospital and community pathogen. Nosocomial infection caused by methicillin-resistant S.aureus(MRSA) is a major problem which may be connected with heavy or prolonged use of antibiotics S.aureus bacteremia caused acute complications, which occasionally resulted in death, and infectious/suppurative complications, which necessitated prolonged antibiotic therapy, sometimes in conjunction with surgery. Therefore, S.aureus bacteremia is a serious medical problem in association with high morbidity and mortality. Methods: 130 patients with S.aureus bacteremia who were admitted in the Kyung Hee University Hospital from January, 1991 to December, 1994 were analyzed retrospectively. We compared the clinical and laboratory characteristics, and antibiotics resistances between MRSA and MSSA bacteremia and also we evaluated risk factors that contribute to fatal outcome in patients with S.aureus bacteremia. Results : 1) of 130cases, 80 were male and 50 were female. The mean age was 44.5±25.1 years. 2) 84(65%) of S.aureus bacteremia were nosocomial and 46(35%) were community-acpuired. The percentage of MRSA stains studied was 55%(71/130) and The percentage of MRSA bacteremia in hospital-acpuired and community-accquired S. aureus bacteremia were 64% (54/84) and 36%(17/46), respectively. Sources of bacteremia were uncertain in 85(65%) with intravascular catheter(20%) and skin wound sites (8%) being the most common sources in remainder(35%) 3) 110(85%) of 130 patients had one or more underlying diseases. Common underlying dieases were cerebrovascular disease(33%), malignancy(17%), Diabetes mellitus(15%), chronic renal failure(8%) and liver cirrhosis(6%). 4) Acute complications occurred in 35 patients and were fatal in 21 5) The risk factors associated with MRSA bacteremia were various severe underlying diseases, vairous invasive procedures, IV catheter-associated infection, hypoalbuminemia, previous use of antibiotics, male sex and old age. 6) The Case fatality rate for patients with S. aureus bacteremia was 18% and those for patients with MRSA and MSSA bactermia were 20% and 12%, respectively. The risk factors that contribute to the increment of mortality rate in patients with S. aureus bacteremia were acute complication, low serum level of total protein, hypoalbuminemia, various invasive procedures and IV catheter-associated infection, 7) In the antibiotic sensitivity test S. aureus was resistant to penicillin in 98.5%, ofloxacin in 73%, cefotaxime in 67%, erythromycin in 58%, aztreonam in 56%, clindamycin in 52%, vancomycin in 0%. 8) In the multiple antibiotic resistance of S. aureus, 43(68%) of MRSA was resistant to more than 10 antibotics, revealing multiply resistant nature of strains, While all but one MSSA was resistant to 1 to 4 antibiotics, one revealing resistance to 8 antibiotics. Conclusion: S. aureus bacteremia is a cause of considerable morbidity and mortality in hospitalized patients who especially, exposed to various risk factors. MRSA revealed higher resistance rate to most antibiotics tested and more marked multiply resistant nature than MSSA. But there was no significant difference in case fatality rate between patients with MRSA and MSSA bacteremia.

Different Clinical Characteristics Among Aeromonas hydrophila, Aeromonas veronii biovar sobria and Aeromonas caviae Monomicrobial Bacteremia

Han-Chuan Chuang,Yu-Huai Ho,Chorng-Jang Lay,Lih-Shinn Wang,Yeong-Shu Tsai,Chen-Chi Tsai 대한의학회 2011 Journal of Korean medical science Vol.26 No.11

This study aimed to compare the clinical presentations of Aeromonas hydrophila, A. veronii biovar sobria and A. caviae monomicrobial bacteremia by a retrospective method at three hospitals in Taiwan during an 8-yr period. There were 87 patients with A. hydrophila bacteremia, 45 with A. veronii biovar sobria bacteremia and 22 with A. caviae bacteremia. Compared with A. hydrophila and A. veronii biovar sobria bacteremia, A. caviae bacteremia was more healthcare-associated (45 vs 30 and 16%; P = 0.031). The patients with A. caviae bacteremias were less likely to have liver cirrhosis (27 vs 62 and 64%;P = 0.007) and severe complications such as shock (9 vs 40 and 47%; P = 0.009) and thrombocytopenia (45 vs 67 and 87%; P = 0.002). The APACHE II score was the most important risk factor of Aeromonas bacteremia-associated mortalities. The APACHE II scores of A. caviae bacteremias were lower than A. hydrophila bacteremia and A. veronii biovar sobria bacteremia (7 vs 14 and 16 points; P = 0.002). In conclusion, the clinical presentation of A. caviae bacteremia was much different from A. hydrophila and A. veronii biovar sobria bacteremia. The severity and mortality of A. caviae bacteremia were lower than A. hydrophila or A. veronii biovar sobria bacteremia.

간경변증에 합병된 균혈증의 임상적 고찰

백승(Seung Paik),김준명(June Myeong Kim),정재복(Jae Bock Chung),박준용(Jun Yong Park),김응(Eung Kim),홍천수(Chein Soo Hong),최흥재(Heung Jai Choi) 대한내과학회 1988 대한내과학회지 Vol.35 No.5

N/A In a nine-year retrospective study, there were S5 episodes (2.24%) of bacteremia among 3789 patients with liver cirrhosis. The total number of causative microorganisms was 87 strains. The mean patient age was 49.6±10.5 years. Of 85 patients, 69 were male and 16 were female giving a ratio of approximately 4.3 to 1. The peak of highest age incidence was the fourth and fifth decades. Community acquired bacteremia numbered 59 episodes and hospital acquired, 26 episodes. In hospital acquired bacteremia, twenty patients (76.9%) underwent one or more major procedures such as gastroscopy, endoscopic sclerotherapy, balloon tamponade, paracentesis, or intraabdominal surgery just before the onset of bacteremia. The causative microorganisms were 72 strains of gram-negative bacteria (82.8%) and 15 strains of gram-positive bacteria (17.2%). Of the more common microorganisms, E. coli accounted for 37.9 percent, Klebsiella 16.1 percent and Staphylococcus 14.9 percent. The incidence of Staphylococcus was relatively high in community acquired bacteremia, and Klebsiella was high in hospital acquired bacteremia. In community acquired bacteremia, E, coli were highly susceptible to aminoglycoside, cefamandole and third generation cephalosporin. Klebsiella were susceptible to aminoglycoside and second and third generation cephalosporin. Staphylococcus were highly susceptible to cephalothin, methicillin and clindamycin. In hospital acquired bacteremia, E. coli were highly susceptible to aminoglycoside and third generation cephalosporin, Klebsiella to aminoglycoside, cephalosporin and chloramphenicol, and Staphylococcus were susceptible to cephalothin, but 50% were susceptible to methicillin, clindamycin, erythromycin and chloramphenicol. Of 85 bacteremic patients with liver cirrhosis, 31 patients (36.5%) died; in community acquired bacteremia, 23 patients (37.7%) died and in hospital acquired bacteremia, 8 patients (30.8%) died. The causes of death were sepsis and/or septic shock, bleeding, hepatic coma, etc. The severity of the cirrhosis was assessed according to Child's grading; 2 patients were found to be in claw A (2.4/c ), 12 in class B (14,1%), and 71 in class C (83.5%), Seventy-three patients suffered from one or more of the following complications: ascites, encephalopathy, hematemesis, and spontaneous bacterial peritonitis. Two or more (mean 2.2) complications were associated with mortality eases, whereas approximately one (mean 1.3) complication was seen in improved patients. In conclusion, patients suffering from liver cirrhosis were highly susceptible to infection because of various defects in the defence system, and when bacteremia developed, the prognosis was very poor. Therefore, bacteremia should be considered a serious complication in liver cirrhosis.

장내구균 균혈증의 임상양상 및 항균제 감수성의 종별 차이 비교 분석

정두련,김양수 대한화학요법학회 1997 대한화학요법학회지 Vol.15 No.1

장내구균은 병원감염의 중요한 원인균으로서 많은 항균제에 대한 내인성내성과 획득내성 및 aminoglycosides에 대한 고도내성으로 인하여 치료상의 문제점을 가지고 있다. 장내구균 균혈증은 그 임상 양상이나 항균제 감수성 등에 있어서 균종 간에 차이를 보이는 것으로 알려져 있으나 국내에서는 이에 대한 연구가 아직 시행된 적이 없었다. 이에 장내구균 균혈증의 균종에 따른 임상양상, 항균제감수성, 사망률 등의 차이를 알아보고자 1992년 3월부터 1995년 8월까지 서울중앙병원에서 혈액배양을 통해 장내구균이 분이 동정된 증례 중 임상적으로 유의한 균혈증에 해당되는 증례 68례를 대상으로 임상조사를 시행하였다. 68례의 균중 중 E. faecalis가 34주, E. faecium이 20주, E. avium이 7주, E. durans가 1주이었고 기타 장내구균종이 6례이었다. 균혈증의 일차 감염원은 담도감염이 35%로 가장 많았고 그 외에 복강내 감염(26%), 혈관내 카테타감영(11%), 심내막염(6%), 요로감염(5%), 창상감염(5%)의 순이었으며 원인이 불분명한 경우가 12%이었다. 병원내 사망의 위험인자 분석상 균혈증의 증증도만이 유의한 위험인자로 나타났다(p=0.003). E. faecalis와 E. faecium에 의한 균혈증은 연령, 성별, 기저질환의 종류 및 그 중증도, 위험인자, 감염전 재원일수, 감염전 항균제의 사용여부, 균혈증의 중증도, 다균성 균혈증의 여부 등에 있어서 차이를 보이지 않았으나 E. faecium의 경우 병원감염이 90%로 E. faecalis의 58%에 비해 유의한 차이를 보였다(p=0.01). 항균제 감수성검사에서는 E. faecalis의 경우 penicillin과 ampicillin에 대해 모두 감수성을 보인 반면 E. faecium의 경우에는 50%에서 내성이 관찰되었고(p<0.001), vancomycin에 대한 내성이 2례(10%)에서 관찰되었다. Aminoglycosides에 대한 고도내성은 균종간에 유의한 차이를 보이지 않았다. 사망률은 단일균성 균혈증만을 대상으로 분석한 경우에 E. faecium 균혈증에서 E. faecalis 균혈증보다 더 높은 병원내 사망률 및 장내구균 균혈증 관련 사망률을 보였다. E. avium 균혈증은 대부분이 담도감염이었으며 penicillin과 ampicillin에 대한 내성률이 29%로서 E. faecalis에 비해 높게 나타났으나 예후는 좋은 편이었다. 기타 장내구균종으로 분류된 군은 E. faecalis와 비교해서 균혈증의 중증도가 유의하게 더 높았고(p=0.003) 사망률도 50%로서 유의하게 높은 결과를 보였다(p=0.03). Penicillin과 ampicillin에 대한 내성률은 각각 67%와 83%로서 E. faecalis와 큰 차이를 보였다(p<0.001). 이상의 결과로 장내구균 균혈증은 그 균종에 EK라 임상적특성, 항균제감수성, 사망률에 있어서 차이를 보였으며 기타 장내구균종의 경우 penicillin이나 ampicillin에 대한 내성률이 균종 중 가장 높고 사망률도 가장 높아 이들에 대한 균종확인 및 연구가 필요할 것으로 생각된다. Background : Enterococci are important nosocomial pathogens with an increasing intrinsic and acquired resistance to antibiotics. Recently various enterococcal species were known to show clinical and microbiologic heterogeneity. Methods : To identify characteristics of enterococcal bacteremia and risk factors for mortality and to understand the clinical and microbiologic differences of bacteremia by various enterococcus species, we analysed 65 patients who had bacteremia due to E. faecalis(50%), E. faecium(29%), E. ovium(10%), E. durans(1%), and unidentified enterococcus species(9%). Results : The common primary sources were the biliary tract(35%), intraabdominal cavity(26%), intravascular catheter(11%), endocarditis(6%), urinary tract(3%), and wounds(5%). Severity of illness was the most significant risk factor for mortality in enterococcus bacteremia. Nosocomial acquisition was more frequently associated with E. faecium bacteremia. Resistance to penicillin or ampicillin was more frequently associated with E. faecium, E. avium, and unidentified enterococcus species bacteremia(29 to 83%) than with E. faecalis bacteremia(0%). Two strains of E. faecium showed resistance to vancomycin. Hrgh-level resistance to aminoglycosides was in 43 to 53%, and it was not significantly different among various enterococcus species. Overall in-hospital mortality rate and bacteremia-related mortality rate were significantly higher in patients with E. faecium bacteremia(50%, 18% respectively) than in those with E. faecalis(12%, 0%) particularly in patients with monomicrobial bacteremia(p<0.05). The prognosis of E. avium bacteremia was relatively good (bacteremia-related mortality rate, 0%), despite of some resistance to penicillin and ampicillin. Conclusion : These results show that various enterococcus species have heterogeneity in clinical feature and antimicrobial succeptibility patterns.

Klebsiella pneumoniae와 Escherichia coli에 의한 지역사회 획득 균혈증의 임상 양상 및 감수성 비교

최영화,이선민,박광주,황성철,이이형,한명호 대한감염학회 2000 감염 Vol.32 No.3

Clinical Characteristics and Antimicrobial Susceptibility Trends in Citrobacter Bacteremia: An 11-Year Single-Center Experience

이래석,최수미,조성진,이제훈,조성연,김시현,이동건,정형석 대한감염학회 2019 Infection and Chemotherapy Vol.51 No.1

Background: Recently, Citrobacter freundii bacteremia outbreak in a neonatal intensive care unit has attracted public attention in Korea. However, Citrobacter bacteremia is uncommon and usually occurs in patients with underlying diseases such as malignancy and hepatobiliary diseases. Increase in resistance and emerging of multidrug resistance among Citrobacter species have gradually been reported. The aim of this study was to investigate the clinical characteristics and outcome of C. freundii and non-freundii bacteremia and antimicrobial susceptibility trends. Materials and Methods: We reviewed the medical records of patients with Citrobacter bacteremia at St. Mary's Hospital, from 2007 to 2017. Results: A total of 43 patients with a median age of 72 (24-93) years was identified and 90.7% of them had comorbidities. Twenty-nine (67.4%) patients had C. freundii bacteremia while 14 had non-freundii bacteremia (six of C. braakii, five of C. koseri, two of C. amalonaticus and one of C. youngae). A total of 26 (51.2%) patients had community-acquired infection and intra-abdominal infection including hepatobiliary tract was the most common portal of entry (24/43, 55.8%). Moreover, hepatobiliary tract was the leading primary site of nosocomial infection (9/17, 52.9%). Polymicrobial bacteremia was observed in 21 (48.8%) patients. The percentages of Citrobacter species susceptible to ampicillin, amikacin, aztreonam, cefazolin, cefoxitin, cefotaxime, cefepime, piperacillin-tazobactam, ciprofloxacin, and imipenem were 9.5%, 97.6%, 73.8%, 9.5%, 14.3%, 71.4%, 92.9%, 83.3%, 83.3% and 100%, respectively. The resistance rate did not increase during the study period. Of 39 patients treated with antibiotics, 36 (92.3%) received appropriate empirical antibiotics. Overall mortality was 18.6%. High Charlson comorbidity index and Pitt bacteremia score were significant risk factors for death in univariate analysis and showed trends in the multivariate analysis. No significant difference in clinical features and antimicrobial susceptibility rate was observed between C. freundii and non-freundii bacteremia. Conclusion: Citrobacter bacteremia was predominant in the elderly with comorbidities, while no pediatric case was observed. Hepatobiliary tract is the leading primary focus of bacteremia both in community-acquired and nosocomial infection. The rate of susceptibility to antibiotics has not changed in the last 11 years.