Temporal trends in Enterobacter species bloodstream infection: A population-based study from 1998-2007

M. N. Al-Hasan, B. D. Lahr, Jeanette E Eckel-Passow, L. M. Baddour

Research output: Contribution to journalArticle

14 Citations (Scopus)

Abstract

Enterobacter species are the fourth most common cause of Gram-negative bloodstream infection (BSI). We examined temporal changes and seasonal variation in the incidence rate of Enterobacter spp. BSI, estimated 28-day and 1-year mortality, and determined in vitro antimicrobial resistance rates of Enterobacter spp. bloodstream isolates in Olmsted County, Minnesota, from 1 January 1998 to 31 December 2007. Multivariable Poisson regression was used to examine temporal changes and seasonal variation in incidence rate and Kaplan-Meier method was used to estimate 28-day and 1-year mortality. The median age of patients with Enterobacter spp. BSI was 58years and 53% were female. The overall age- and gender-adjusted incidence rate of Enterobacter spp. BSI was 3.3 per 100000 person-years (95% CI 2.3-4.4). There was a linear trend of increasing incidence rate from 0.8 (95% CI 0-1.9) to 6.2 (95% CI 3.0-9.3) per 100000 person-years between 1998 and 2007 (p0.002). There was no significant difference in the incidence rate of Enterobacter spp. BSI during the warmest 4months compared to the remainder of the year (incidence rate ratio 1.06; 95% CI 0.47-2.01). The overall 28-day and 1-year mortality rates of Enterobacter spp. BSI were 21% (95% CI 8-34%) and 38% (95% CI 22-53%), respectively. Up to 13% of Enterobacter spp. bloodstream isolates were resistant to third-generation cephalosporins. To our knowledge, this is the first population-based study to describe the epidemiology and outcome of Enterobacter spp. BSI. The increase in incidence rate of Enterobacter spp. BSI over the past decade, coupled with its associated antimicrobial resistance, dictate the need for further investigation of this syndrome.

Original languageEnglish (US)
Pages (from-to)539-545
Number of pages7
JournalClinical Microbiology and Infection
Volume17
Issue number4
DOIs
StatePublished - Apr 2011

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Enterobacter
Infection
Population
Incidence
Mortality
Cephalosporins
Epidemiology

Keywords

  • Antimicrobial resistance
  • Bacteraemia
  • Enterobacter
  • Epidemiology
  • Incidence
  • Mortality
  • Seasonal variation

ASJC Scopus subject areas

  • Microbiology (medical)
  • Infectious Diseases

Cite this

Temporal trends in Enterobacter species bloodstream infection : A population-based study from 1998-2007. / Al-Hasan, M. N.; Lahr, B. D.; Eckel-Passow, Jeanette E; Baddour, L. M.

In: Clinical Microbiology and Infection, Vol. 17, No. 4, 04.2011, p. 539-545.

Research output: Contribution to journalArticle

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abstract = "Enterobacter species are the fourth most common cause of Gram-negative bloodstream infection (BSI). We examined temporal changes and seasonal variation in the incidence rate of Enterobacter spp. BSI, estimated 28-day and 1-year mortality, and determined in vitro antimicrobial resistance rates of Enterobacter spp. bloodstream isolates in Olmsted County, Minnesota, from 1 January 1998 to 31 December 2007. Multivariable Poisson regression was used to examine temporal changes and seasonal variation in incidence rate and Kaplan-Meier method was used to estimate 28-day and 1-year mortality. The median age of patients with Enterobacter spp. BSI was 58years and 53{\%} were female. The overall age- and gender-adjusted incidence rate of Enterobacter spp. BSI was 3.3 per 100000 person-years (95{\%} CI 2.3-4.4). There was a linear trend of increasing incidence rate from 0.8 (95{\%} CI 0-1.9) to 6.2 (95{\%} CI 3.0-9.3) per 100000 person-years between 1998 and 2007 (p0.002). There was no significant difference in the incidence rate of Enterobacter spp. BSI during the warmest 4months compared to the remainder of the year (incidence rate ratio 1.06; 95{\%} CI 0.47-2.01). The overall 28-day and 1-year mortality rates of Enterobacter spp. BSI were 21{\%} (95{\%} CI 8-34{\%}) and 38{\%} (95{\%} CI 22-53{\%}), respectively. Up to 13{\%} of Enterobacter spp. bloodstream isolates were resistant to third-generation cephalosporins. To our knowledge, this is the first population-based study to describe the epidemiology and outcome of Enterobacter spp. BSI. The increase in incidence rate of Enterobacter spp. BSI over the past decade, coupled with its associated antimicrobial resistance, dictate the need for further investigation of this syndrome.",
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