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Overview :
Kang et al identified risk factors for broad-spectrum
cephalosporin resistance and 30 day mortality in patients with bacteremia caused
by Enterobacter species. This can help identify patients who may require more
aggressive management and closer monitoring. The authors are from the Seoul
National University College of Medicine in Korea.
Criteria for broad-spectrum resistance: in vitro resistance
to cefotaxime OR ceftazidime
Independent risk factors on multivariate analysis associated
with bacteremia caused by broad-spectrum cephalosporin resistant Enterobacter
species (Table 2, page 815):
(1)previous receipt of broad spectrum cephalosporin
antibiotics
(2) previous receipt of aminoglycosides
(3) presence of an invasive procedure within previous 72
hours
(4) care in the ICU
Additional risk factors for bacteremia caused by
broad-spectrum cephalosporin resistant Enterobacter species (Table 2, page
815):
(1) prolonged hospital stay (>= 2 weeks)
(2) nosocomial acquisition of the infection
(3) postoperative
(4) presence of an indwelling urinary catheter
(5) presence of a central venous catheter
(6) receipt of antibiotics in past 30 days
(7) previous receipt of metronidazole
(8) previous receipt of a penicillin
(9) previous receipt of a fluoroquinolone
Risk factors for 30 days mortality in a patient with
Enterobacter species (Table 4, page 817):
(1) broad-spectrum cephalosporin resistance
(2) prolonged hospital stay (>= 2 weeks)
(3) presentation of bacteremia as septic shock
(4) care in the ICU
(5) primary site of infection unknown
(6) APACHE II score >= 8 (higher risk if >= 16) or
increasing
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