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Open Access Highly Accessed Research article

Severe community-acquired Enterobacter pneumonia: a plea for greater awareness of the concept of health-care-associated pneumonia

Alexandre Boyer123*, Brice Amadeo23, Frédéric Vargas1, Ma Yu1, Sylvie Maurice-Tison4, Véronique Dubois5, Cécile Bébéar5, Anne Marie Rogues23 and Didier Gruson1

Author Affiliations

1 Medical Intensive Care Unit, Hôpital Pellegrin-Tripode, Place Amélie Raba Léon, 33076 Bordeaux cedex, France

2 Université de Bordeaux, INSERM U657, F-33000 Bordeaux, France

3 INSERM, U657, F-33000 Bordeaux, France

4 Institut de Santé Publique d'Epidémiologie et de Développement, Université de Bordeaux 2, 146, rue Léo Saignat, 33076 Bordeaux cedex, France

5 Service de Bactériologie, Hôpital Pellegrin-Tripode, Place Amélie Raba Léon, 33076 Bordeaux cedex, France

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BMC Infectious Diseases 2011, 11:120  doi:10.1186/1471-2334-11-120

Published: 11 May 2011



Patients with Enterobacter community-acquired pneumonia (EnCAP) were admitted to our intensive care unit (ICU). Our primary aim was to describe them as few data are available on EnCAP. A comparison with CAP due to common and typical bacteria was performed.


Baseline clinical, biological and radiographic characteristics, criteria for health-care-associated pneumonia (HCAP) were compared between each case of EnCAP and thirty age-matched typical CAP cases. A univariate and multivariate logistic regression analysis was performed to determine factors independently associated with ENCAP. Their outcome was also compared.


In comparison with CAP due to common bacteria, a lower leukocytosis and constant HCAP criteria were associated with EnCAP. Empiric antibiotic therapy was less effective in EnCAP (20%) than in typical CAP (97%) (p < 0.01). A delay in the initiation of appropriate antibiotic therapy (3.3 ± 1.6 vs. 1.2 ± 0.6 days; p < 0.01) and an increase in duration of mechanical ventilation (8.4 ± 5.2 vs. 4.0 ± 4.3 days; p = 0.01) and ICU stay were observed in EnCAP patients.


EnCAP is a severe infection which is more consistent with HCAP than with typical CAP. This retrospectively suggests that the application of HCAP guidelines should have improved EnCAP management.

health-care-associated pneumonia; community-acquired pneumonia; Enterobacter cloacae; Enterobacter aerogenes; Gram-negative pneumonia