Infect Chemother.  2016 Dec;48(4):274-284. 10.3947/ic.2016.48.4.274.

Clinical and Therapeutic Implications of Aeromonas Bacteremia: 14 Years Nation-Wide Experiences in Korea

• Rhee JY
• Jung DS
• Peck KR

• KMID: 2441321
• DOI: http://doi.org/10.3947/ic.2016.48.4.274

Abstract

BACKGROUND
To elucidate the clinical presentation, antimicrobial susceptibility, and prognostic factors of monomicrobial Aeromonas bacteremia in order to determine the most effective optimal therapy.
MATERIALS AND METHODS
We reviewed the medical records of Aeromonas bacteremia patients for the period January 2000 to December 2013 in a retrospective multi-center study.
RESULTS
A total of 336 patient records were reviewed, with 242 having community-acquired bacteremia. The major clinical infections were of the hepatobiliary tract (50.6%) and peritonitis (18.5%), followed by primary bacteremia (17.9%). The infections usually occurred in patients with malignancy (42.3%), hepatic cirrhosis (39.3%), or diabetes mellitus (25.6%). High antimicrobial-resistance rates (15.5% for ceftriaxone, 15.5% for piperacillin/tazobactam) were noted. However, resistance to carbapenem and amikacin was only 9.8% and 3.0%, respectively. Aeromonas hydrophila (58.9%) was the most common pathogen, followed by Aeromonas caviae (30.4%). The severity of A. caviae bacteremia cases were less than that of A. hydrophila or Aeromonas veronii bacteremia (P <0.05). A. hydrophila showed higher antimicrobial resistance than did other Aeromonas species (P <0.05). Patients with hospital-acquired bacteremia were more likely to have severely abnormal laboratory findings and relatively high antimicrobial-resistance rates. Mortality was associated with metastatic cancer, shock, delayed use of appropriate antimicrobial agents, increased prothrombin time, and increased creatinine level (P <0.05).
CONCLUSIONS
Aeromonas species should be considered one of the causative agents of bacteremia in patients with intra-abdominal infections or malignancies. Although ceftriaxone-resistant Aeromonas bacteremia was not statistically related to mortality in this study, it was associated with severe clinical manifestations and laboratory abnormalities. Appropriate antibiotics, including carbapenem, should be administered early, especially in Aeromonas bacteremia patients with shock and impaired renal function.

Keyword

Aeromonas; Antimicrobial resistance; Bacteremia; Risk factors

MeSH Terms

Aeromonas caviae
Aeromonas hydrophila
Aeromonas*
Amikacin
Animals
Anti-Bacterial Agents
Anti-Infective Agents
Bacteremia*
Ceftriaxone
Creatinine
Diabetes Mellitus
Guinea Pigs
Humans
Intraabdominal Infections
Korea*
Liver Cirrhosis
Medical Records
Mortality
Peritonitis
Prothrombin Time
Retrospective Studies
Risk Factors
Shock
Amikacin
Anti-Bacterial Agents
Anti-Infective Agents
Ceftriaxone
Creatinine

Figure

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  Figure 1 Monthly distribution of Aeromonas bacteremia

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