Severe community-acquired Enterobacter pneumonia: a plea for greater awareness of the concept of health-care-associated pneumonia

BMC Infect Dis. 2011 May 11:11:120. doi: 10.1186/1471-2334-11-120.

Abstract

Background: Patients with Enterobacter community-acquired pneumonia (EnCAP) were admitted to our intensive care unit (ICU). Our primary aim was to describe them as few data are available on EnCAP. A comparison with CAP due to common and typical bacteria was performed.

Methods: Baseline clinical, biological and radiographic characteristics, criteria for health-care-associated pneumonia (HCAP) were compared between each case of EnCAP and thirty age-matched typical CAP cases. A univariate and multivariate logistic regression analysis was performed to determine factors independently associated with ENCAP. Their outcome was also compared.

Results: In comparison with CAP due to common bacteria, a lower leukocytosis and constant HCAP criteria were associated with EnCAP. Empiric antibiotic therapy was less effective in EnCAP (20%) than in typical CAP (97%) (p < 0.01). A delay in the initiation of appropriate antibiotic therapy (3.3 ± 1.6 vs. 1.2 ± 0.6 days; p < 0.01) and an increase in duration of mechanical ventilation (8.4 ± 5.2 vs. 4.0 ± 4.3 days; p = 0.01) and ICU stay were observed in EnCAP patients.

Conclusions: EnCAP is a severe infection which is more consistent with HCAP than with typical CAP. This retrospectively suggests that the application of HCAP guidelines should have improved EnCAP management.

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Anti-Bacterial Agents / therapeutic use
  • Awareness*
  • Community-Acquired Infections / drug therapy
  • Community-Acquired Infections / microbiology
  • Community-Acquired Infections / psychology*
  • Cross Infection / drug therapy
  • Cross Infection / microbiology
  • Cross Infection / psychology*
  • Enterobacter / genetics
  • Enterobacter / isolation & purification*
  • Enterobacter / physiology
  • Female
  • Hospitalization
  • Humans
  • Intensive Care Units
  • Male
  • Middle Aged
  • Pneumonia, Bacterial / drug therapy
  • Pneumonia, Bacterial / microbiology
  • Pneumonia, Bacterial / psychology*
  • Retrospective Studies
  • Severity of Illness Index

Substances

  • Anti-Bacterial Agents