Clinical features and therapeutic implications of 104 episodes of monomicrobial Aeromonas bacteraemia

Abstract

Objectives: Aeromonas bacteraemia is not a common infectious disease, but can cause a grave outcome in infected cases. In this study, clinical presentations and prognostic factors of cases of monomicrobial Aeromonas bacteraemia were analysed. Also, the impact of beta-lactam and aminoglycoside in combination and of emerging cephalosporin-resistance during therapy was discussed.

Methods: From 1989 to 1998 in a medical centre in southern Taiwan, those cases with monomicrobial Aeromonas bacteraemia were included for study.

Results: A total of 104 episodes of monomicrobial Aeromonas bacteraemia, accounting for 74% of all Aeromonas bacteraemia, were encountered. The infections usually occurred in the patients with hepatic cirrhosis (54%) or malignancy (21%) and were community-acquired (74%). Cases of community-acquired bacteraemia were more likely to have cirrhosis, a high severity score at onset, and a worse prognosis than those of nosocomial bacteraemia did and nosocomial isolates were less susceptible to cefoxitin and cefotaxime. Forty-three percent of cases had a concomitant infection focus, such as primary peritonitis, invasive cellulitis or necrotizing fasciitis, biliary tract or burn wound infections. Crude fatality rate within 2 weeks after the onset was 30%. Secondary bacteraemia and a higher severity score ( > or = 4) for illness at the first presentation were independently associated with a fatal outcome. The therapeutic superiority of beta-lactam and aminoglycoside in combination cannot be demonstrated in patients with Aeromonas bacteraemia. Cefotaxime resistance emerged in 3.4% of 58 patients treated with a cephalosporin for at least 72 h. None of the community-acquired isolates, but one-quarter of the nosocomial isolates, were resistant to cefotaxime.

Conclusions: Aeromonas bacteraemia usually occurred in patients with liver cirrhosis or malignancy, and heralded a poor prognosis, especially while associated with a relevant infectious source or with a higher severity score at presentation. The superiority of aminoglycoside and beta-lactam in combination cannot be demonstrated while treating those patients, and the emergence of antimicrobial resistance to cephalosporin was a rare event during cephalosporin therapy. Thus, a broad-spectrum cephalosporin remains one of the antimicrobial alternatives for invasive community-acquired Aeromonas infections.