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Newly Named Klebsiella aerogenes (formerly Enterobacter aerogenes) Is Associated with Poor Clinical Outcomes Relative to Other Enterobacter Species in Patients with Bloodstream Infection.

Publication ,  Journal Article
Wesevich, A; Sutton, G; Ruffin, F; Park, LP; Fouts, DE; Fowler, VG; Thaden, JT
Published in: J Clin Microbiol
August 24, 2020

Enterobacter aerogenes was recently renamed Klebsiella aerogenes This study aimed to identify differences in clinical characteristics, outcomes, and bacterial genetics among patients with K. aerogenes versus Enterobacter species bloodstream infections (BSI). We prospectively enrolled patients with K. aerogenes or Enterobacter cloacae complex (Ecc) BSI from 2002 to 2015. We performed whole-genome sequencing (WGS) and pan-genome analysis on all bacteria. Overall, 150 patients with K. aerogenes (46/150 [31%]) or Ecc (104/150 [69%]) BSI were enrolled. The two groups had similar baseline characteristics. Neither total in-hospital mortality (13/46 [28%] versus 22/104 [21%]; P = 0.3) nor attributable in-hospital mortality (9/46 [20%] versus 13/104 [12%]; P = 0.3) differed between patients with K. aerogenes versus Ecc BSI, respectively. However, poor clinical outcome (death before discharge, recurrent BSI, and/or BSI complication) was higher for K. aerogenes than Ecc BSI (32/46 [70%] versus 42/104 [40%]; P = 0.001). In a multivariable regression model, K. aerogenes BSI, relative to Ecc BSI, was predictive of poor clinical outcome (odds ratio 3.3; 95% confidence interval 1.4 to 8.1; P = 0.008). Pan-genome analysis revealed 983 genes in 323 genomic islands unique to K. aerogenes isolates, including putative virulence genes involved in iron acquisition (n = 67), fimbriae/pili/flagella production (n = 117), and metal homeostasis (n = 34). Antibiotic resistance was largely found in Ecc lineage 1, which had a higher rate of multidrug resistant phenotype (23/54 [43%]) relative to all other bacterial isolates (23/96 [24%]; P = 0.03). K. aerogenes BSI was associated with poor clinical outcomes relative to Ecc BSI. Putative virulence factors in K. aerogenes may account for these differences.

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Published In

J Clin Microbiol

DOI

EISSN

1098-660X

Publication Date

August 24, 2020

Volume

58

Issue

9

Location

United States

Related Subject Headings

  • Sepsis
  • Microbiology
  • Humans
  • Enterobacter aerogenes
  • Enterobacter
  • Bacteremia
  • Anti-Bacterial Agents
  • 3207 Medical microbiology
  • 3202 Clinical sciences
  • 11 Medical and Health Sciences
 

Citation

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Wesevich, A., Sutton, G., Ruffin, F., Park, L. P., Fouts, D. E., Fowler, V. G., & Thaden, J. T. (2020). Newly Named Klebsiella aerogenes (formerly Enterobacter aerogenes) Is Associated with Poor Clinical Outcomes Relative to Other Enterobacter Species in Patients with Bloodstream Infection. J Clin Microbiol, 58(9). https://doi.org/10.1128/JCM.00582-20
Wesevich, Austin, Granger Sutton, Felicia Ruffin, Lawrence P. Park, Derrick E. Fouts, Vance G. Fowler, and Joshua T. Thaden. “Newly Named Klebsiella aerogenes (formerly Enterobacter aerogenes) Is Associated with Poor Clinical Outcomes Relative to Other Enterobacter Species in Patients with Bloodstream Infection.J Clin Microbiol 58, no. 9 (August 24, 2020). https://doi.org/10.1128/JCM.00582-20.

Published In

J Clin Microbiol

DOI

EISSN

1098-660X

Publication Date

August 24, 2020

Volume

58

Issue

9

Location

United States

Related Subject Headings

  • Sepsis
  • Microbiology
  • Humans
  • Enterobacter aerogenes
  • Enterobacter
  • Bacteremia
  • Anti-Bacterial Agents
  • 3207 Medical microbiology
  • 3202 Clinical sciences
  • 11 Medical and Health Sciences