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

Alexandre Boyer 1, 2, * Brice Amadeo 2 Frédéric Vargas 1 Ma Yu 1 Sylvie Maurice-Tison 3 Véronique Dubois 4 Cécile Bébéar 4 Anne Rogues 2 Didier Gruson 1
* Auteur correspondant
1 Medical Intensive Care Unit
2 Pharmacoepidemiologie et évaluation de l'impact des produits de santé sur les populations
3 Institut de Santé Publique d'Epidémiologie et de Développement
4 Service de Bactériologie
Abstract : 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.
Keywords : Gram-negative pneumonia Enterobacter aerogenes health-care-associated pneumonia community-acquired pneumonia Enterobacter cloacae
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Article dans une revue
BMC Infectious Diseases, BioMed Central, 2011, 11 (1), pp.120. 〈10.1186/1471-2334-11-120〉
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Alexandre Boyer, Brice Amadeo, Frédéric Vargas, Ma Yu, Sylvie Maurice-Tison, et al.. Severe community-acquired Enterobacter pneumonia: a plea for greater awareness of the concept of health-care-associated pneumonia.. BMC Infectious Diseases, BioMed Central, 2011, 11 (1), pp.120. 〈10.1186/1471-2334-11-120〉. 〈inserm-00601548〉

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