Clinical Implications of Species Identification in Monomicrobial Aeromonas Bacteremia

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Wu, Chi-Jung ; Chen, Po-Lin ; Hsueh, Po-Ren ; Chang, Ming-Chung ; Tsai, Pei-Jane ; Shih, Hsin-I ; Wang, Hsuan-Chen ; Chou, Pei-Hsin ; Ko, Wen-Chien (2015)
  • Publisher: Figshare
  • Related identifiers: doi: 10.1371/journal.pone.0117821
  • Subject: veronii | cefotaxime resistance rates | species | dhakensis bacteremia | caviae | monomicrobial aeromonas bacteremia | hydrophila | Biological Sciences | monomicrobial aeromonas bacteremia backgroundadvances | aeromonas bacteremia
    mesheuropmc: bacterial infections and mycoses

<div><p>Background</p><p>Advances in <i>Aeromonas</i> taxonomy have led to the reclassification of aeromonads. Hereon, we aimed to re-evaluate the characteristics of <i>Aeromonas</i> bacteremia, including those of a novel species, <i>Aeromonas dhakensis</i>.</p><p>Methodology/Principal Findings</p><p>A retrospective study of monomicrobial <i>Aeromonas</i> bacteremia at a medical center in southern Taiwan from 2004–2011 was conducted. Species identification was based on <i>rpoB</i> sequencing. Of bacteremia of 153 eligible patients, <i>A. veronii</i> (50 isolates, 32.7%), <i>A. dhakensis</i> (48, 31.4%), <i>A. caviae</i> (43, 28.1%), and <i>A. hydrophila</i> (10, 6.5%) were the principal causative species. <i>A. dhakensis</i> and <i>A. veronii</i> bacteremia were mainly community-acquired and presented as primary bacteremia, spontaneous bacterial peritonitis, or skin and soft-tissue infection, whereas <i>A. caviae</i> was associated with hospital-onset bacteremia. The distribution of the AmpC β-lactamase and metallo-β-lactamase genes was species-specific: <i>bla</i><sub>AQU-1</sub>, <i>bla</i><sub>MOX</sub>, or <i>bla</i><sub>CepH</sub> was present in <i>A. dhakensis</i>, <i>A. caviae</i>, or <i>A. hydrophila</i>, respectively, and <i>bla</i><sub>CphA</sub> was present in <i>A. veronii</i>, <i>A. dhakensis</i>, and <i>A. hydrophila</i>. The cefotaxime resistance rates of the <i>A. caviae</i>, <i>A. dhakensis</i>, and <i>A. hydrophila</i> isolates were higher than that of <i>A. veronii</i> (39.5%%, 25.0%, and 30% <i>vs.</i> 2%, respectively). <i>A. dhakensis</i> bacteremia was linked to the highest 14-day sepsis-related mortality rate, followed by <i>A. hydrophila</i>, <i>A. veronii</i>, and <i>A. caviae</i> bacteremia (25.5%, 22.2%, 14.0%, and 4.7%, respectively; <i>P</i> = 0.048). Multivariate analysis revealed that <i>A. dhakensis</i> bacteremia, active malignancies, and a Pitt bacteremia score ≥ 4 was an independent mortality risk factor.</p><p>Conclusions/Significance</p><p>Characteristics of <i>Aeromonas</i> bacteremia vary between species. <i>A. dhakensis</i> prevalence and its associated poor outcomes suggest it an important human pathogen.</p></div>
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