Clinical Characteristics and Risk Factors for Multidrug-Resistant Enterobacter cloacae Complex Bacteremia in a Chinese Tertiary Hospital: A Decade Review (2013–2022)

Abstract

Objective This study aimed to analyze the antimicrobial resistance profiles, the clinical characteristics and risk factors of bacteremia caused by Enterobacter cloacae complex (ECC) strains. Methods Clinical information of patients diagnosed with bacteremia caused by ECC from 2013 to 2022 were collected retrospectively. The clinical data of these patients were then analyzed in subgroups based on multidrug resistance (MDR), nosocomial acquired, polymicrobial bacteremia and mortality. Results The ECC strains showed the highest resistant rates to ceftriaxone (39.9%), followed by ceftazidime (36.7%) and aztreonam (31.2%). The proportion of MDR ECC was 30.9% (58/188). The analysis revealed that initial empirical antibiotic therapy was a robust and independent risk factor (OR = 3.193, 95%CI 1.203–8.479, P < 0.020), whereas, appropriately empirical therapy significantly reduced the risk (OR = 0.279, 95%CI 0.130–0.598, P < 0.001) of MDR-ECC bacteremia. In addition, ICU admission was identified as independent risk factors in patients with polymicrobial bacteremia (P = 0.009). Moreover, diagnostic procedure (endoscopy) (P = 0.009) and blood transfusion (P = 0.003) were independent risk factors for mortality. Conclusion Carbapenems and amikacin as the most effective treatments for ECC bacteremia. Initial empirical antibiotic therapy was an independent risk factor, and appropriate empirical therapy was a protective factor for patients with MDR ECC bacteremia. ICU admission was an independent risk factor for polymicrobial bacteremia. Both endoscopy and blood transfusion are associated with mortality of ECC Bacteremia. Control of MDR ECC bacteremia requires a cooperative and comprehensive approach, including strategies for identification of resistant organisms, risk factor detection and implementation strategies of infection-control and prevention.