Emergence of Enterobacter aerogenes as a major antibiotic-resistant nosocomial pathogen in Belgian hospitals

Abstract

Objective: To study the epidemiology of Enterobacter aerogenes infections in Belgian hospitals and determine whether recent trends show an increase in incidence of E. aerogenes infections and antimicrobial resistance. Methods: Data from the bloodstream infection component of the National Surveillance of Hospital infections (October 1992 to September 1996 data in 45 hospitals) and from a retrospective study on E. aerogenes clinical isolates (1994 and 1995 data in 41 hospitals) were analyzed. Results: E. aerogenes was recovered from clinical specimens with a mean incidence of 4.6 isolates per 10,000 patient-days and caused 0.20 bloodstream infections per 10 000 patient-days during the surveyed periods, respectively. Both rates increased significantly throughout the years. The proportion of E. aerogenes within the Enterobacter genus was 35.4% in clinical isolates and 41.2% in bloodstream infections. Both proportions significantly increased over time. Incidence was not statistically different by hospital size but showed major differences between geographic regions. Resistance rates to third-generation cephalosporins and fluoroquinolones increased, and imipenem resistance emerged in several hospitals. Conclusions: This report provides evidence of an increase in E. aerogenes infections in Belgian hospitals and documents an increase in antimicrobial resistance of E. aerogenes strains. These figures provide a baseline for further surveillance data.