Clinical characteristics of Aeromonas bacteremia at Hiroshima University Hospital:Literature review and therapeutic proposal

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[Introduction] The genus Aeromonas is native to mesophilic freshwater environments. Aeromonas infections are rare in non-tropical areas with well-equipped water supply facilities. However, some cases of severe Aeromonas septicemia and Necrotizing Soft Tissue Infection (NSTI) caused by bacterial translocation have been reported in Japan. [Methods] We examined all culture tests submitted to our Hospital over a 14 years period (2004 - 2017). We identified 21 cases in which Aeromonas was isolated from blood culture. Information relating to medical history and clinical course were collected for each of these cases. In addition, we analyzed various factors against Aeromonas bacteremia. [Results] The total number of culture samples inspected was 248,790, comprising 58,739 (19.7%) blood culture samples. The total number of blood culture from which Aeromonas was isolated was 21cases. 11 cases (52.4%) fulfilled the criteria of septic shock. Of these, 3 died, of which 2 had advanced to NSTI. 15 cases (71.4%) had underlying hepatobiliary disease and 7 cases had undergone hepatobiliary invasion examinations. There was a significant difference between the time to start of antibiotic treatment and the mortality rate. [Conclusions] Gastroenterological invasive examinations can increase Aeromonas bacteremia due to bacterial translocation. When Aeromonas septicemia is suspected, immediate empiric therapy is crucial.