Effect of antimicrobial therapy on mortality in 377 episodes of Enterobacter spp. bacteraemia

Marcos, Miguel; Iñurrieta, Amaia; Soriano, Álex; Martínez, José Antonio; Almela, Manel; Marco, Francesc

doi:10.1093/jac/dkn155

Cited by 36 publications

(25 citation statements)

References 32 publications

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“…There were few studies investigating clinical characteristics of bacteremia caused by ESBL-producing E. cloacae though E. cloacae has emerged as a major pathogen causing nosocomial bloodstream infections worldwide in recent years (5,21). A recent report demonstrated the mortality and effects of antibiotic therapy in patients with E. cloacae bacteremia but did not discuss the clinical impact of ESBL production (15). In the present study, compared with bacteremia due to cefotaxime-nonsusceptible E. cloacae isolates without ESBL production, patients in the ESBL group were more likely to have complications of breakthrough bacteremia and a longer hospital stay.…”

Section: Discussioncontrasting

confidence: 66%

Bacteremia Due to Extended-Spectrum-β-Lactamase-Producing Enterobacter cloacae : Role of Carbapenem Therapy

Lee

Yan³

et al. 2010

Antimicrob Agents Chemother

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Enterobacter cloacae is an important nosocomial pathogen. However, few studies specifically dealing with the clinical characteristics and outcome of extended-spectrum ␤-lactamase (ESBL)-producing E. cloacae infections have been published. During an 8-year period in a medical center, of 610 E. cloacae bacteremic isolates, 138 (22.6%) with ESBL genes were designated the ESBL group, and 120 (19.6%) cefotaxime-nonsusceptible isolates without the ESBL phenotype and genes were designated the control group. Of the former group of isolates, 133 (96.3%) carried the bla SHV-12 gene, 3 (2.1%) had bla CTX-M3 , and 2 (1.4%) had both the bla SHV-12 and bla CTX-M3 genes. After patients under the age of 18 years were excluded, there were 206 adults with E. cloacae bacteremia, and these consisted of 121 patients in the ESBL group and 85 in the control group. More episodes of hospital-onset and polymicrobial bacteremia, increased severity of illness, more cases of bacteremia onset in intensive care units (ICUs), and longer stays in the hospital and ICU after bacteremia onset were noted in the ESBL group. However, the crude and sepsis-related mortality rates in two groups were similar. Of the ESBL group, the in-hospital sepsis-related mortality rate of patients definitively treated by a carbapenem was lower than that of those treated by noncarbapenem ␤-lactams (5/53, or 9.4%, versus 13/44, or 29.5%; P ‫؍‬ 0.01) though the difference was not significant in the hierarchical multivariate analysis (P ‫؍‬ 0.46). Among 62 patients with follow-up blood cultures within 14 days of bacteremia onset, breakthrough bacteremia was more common in those treated by a noncarbapenem ␤-lactam agent than in those treated by a carbapenem (18/31, or 58.0%, versus 3/31, or 9.6%; P < 0.001). Thus, carbapenem therapy for ESBL-producing E. cloacae that cause bacteremia may provide therapeutic benefits.Enterobacter cloacae is an increasingly important nosocomial pathogen and causes a wide spectrum of infections involving the urinary tract, lower respiratory tract, skin and soft tissue, biliary tract, wounds, intravenous catheters, and the central nervous system (21). It is traditionally characterized by chromosomally encoded AmpC ␤-lactamases and obtains the ability to develop resistance upon exposure to broad-spectrum cephalosporins (10), but a growing number of E. cloacae strains with extended-spectrum ␤-lactamases (ESBLs) have been observed worldwide, including in Taiwan (1, 2, 23, 28).Based on previous reports concerning Taiwan, the prevalence of ESBL-producing E. cloacae was 15 to 28%, with the dominance of strain SHV-12 (1, 25, 27, 28). However, the impact of this resistance on mortality is still under debate (4, 9, 28), and few studies dealing specially with the clinical implications of ESBL-producing E. cloacae have been published. Moreover, carbapenem was considered a first choice for treatment of severe infections caused by ESBL-producing Enterobacteriaceae other than E. cloacae, such as Klebsiella pneumoniae and Escherichia coli (17). However, the...

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Section: Discussioncontrasting

confidence: 66%

Bacteremia Due to Extended-Spectrum-β-Lactamase-Producing Enterobacter cloacae : Role of Carbapenem Therapy

Lee

Yan³

et al. 2010

Antimicrob Agents Chemother

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“…Our findings are consistent with those of other recent studies (16)(17)(18). A Spanish study spanning a 16-year time period (1991 to 2006) analyzed 377 episodes of Enterobacter spp.…”

Section: Discussionsupporting

confidence: 93%

“…A Spanish study spanning a 16-year time period (1991 to 2006) analyzed 377 episodes of Enterobacter spp. bacteremia and found piperacillin-tazobactam-treated patients had a lower mortality rate than those who received third-generation cephalosporins, carbapenems, ciprofloxacin, or gentamicin (17). However, only 38 patients received piperacillin-tazobactam in this cohort, and for some the treatments were changed to other definitive therapies.…”

Section: Discussionmentioning

confidence: 80%

Piperacillin-Tazobactam versus Other Antibacterial Agents for Treatment of Bloodstream Infections Due to AmpC β-Lactamase-Producing Enterobacteriaceae

Cheng

Nelson

Mehta

et al. 2017

Antimicrob Agents Chemother

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In vivo induction of AmpC beta-lactamases produces high-level resistance to many beta-lactam antibiotics in Enterobacteriaceae, often resulting in the need to use carbapenems or cefepime (FEP). The clinical effectiveness of piperacillintazobactam (TZP), a weak inducer of AmpC beta-lactamases, is poorly understood. Here, we conducted a case-control study of adult inpatients with bloodstream infections (BSIs) due to Enterobacter, Serratia, or Citrobacter species from 2009 to 2015 to assess outcomes following treatment with TZP compared to FEP or meropenem (MEM). We collected clinical data and screened all isolates for the presence of ampC alleles by PCR. Primary study outcomes were 30-day mortality and persistent bacteremia at Ն72 h from the time of treatment initiation. Of 493 patients with bacteremia, 165 patients met the inclusion criteria, of which 88 were treated with TZP and 77 with FEP or MEM. To minimize differences between covariates, we carried out propensity score matching, which yielded 41 matched pairs. Groups only differed by age, with patients in the TZP group significantly older (P ϭ 0.012). There were no significant differences in 30-day mortality, persistent bacteremia, 7-day mortality, or treatment escalation between the two treatment groups, including in the propensity score-matched cohort. PCR amplification and sequencing of ampC genes revealed the presence of ampC in isolates with cefoxitin MICs below 16 g/ml, in particular in Serratia spp., and demonstrated that these alleles were highly genetically diverse. Taken together, TZP may be a valuable treatment option for BSIs due to AmpC betalactamase-producing Enterobacteriaceae, diminishing the need for broader-spectrum agents. Future studies are needed to validate these findings.

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“…Kaye et al found that PTZ use was not associated with the emergence of cephalosporin resistance in the treatment of Enterobacter bacteraemia (RR = 1.1, 95% CI 0.4-2.7; P = 0.90) [25]. In another study analysing 377 episodes of Enterobacter bacteraemia in adults, the only factor independently associated with a reduction in 30-day mortality was the early use of PTZ [96]. However, another study comparing the risk of isolating a cephalosporin-resistant Enterobacter following PTZ or broad-spectrum cephalosporin therapy showed that both antibiotics conferred the same risk (resistant isolates occurred in 2% for both groups, RR = 1.02; P = 0.95) and that quinolones were protective (RR = 0.24; P = 0.003) [97].…”

Section: Clinical Efficacy Of Piperacillin/tazobactammentioning

confidence: 99%

Antibiotic therapy for inducible AmpC β-lactamase-producing Gram-negative bacilli: what are the alternatives to carbapenems, quinolones and aminoglycosides?

Harris

Ferguson

2012

International Journal of Antimicrobial Agents

108

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Effect of antimicrobial therapy on mortality in 377 episodes of Enterobacter spp. bacteraemia

Abstract: Enterobacter spp. are an increasing cause of bacteraemia. The empirical use of piperacillin/tazobactam was independently associated with a lower 30 day mortality rate.

Cited by 36 publications

References 32 publications

Bacteremia Due to Extended-Spectrum-β-Lactamase-Producing Enterobacter cloacae : Role of Carbapenem Therapy

Bacteremia Due to Extended-Spectrum-β-Lactamase-Producing Enterobacter cloacae : Role of Carbapenem Therapy

Piperacillin-Tazobactam versus Other Antibacterial Agents for Treatment of Bloodstream Infections Due to AmpC β-Lactamase-Producing Enterobacteriaceae

Antibiotic therapy for inducible AmpC β-lactamase-producing Gram-negative bacilli: what are the alternatives to carbapenems, quinolones and aminoglycosides?

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