Enterobacter Bacteremia: Clinical Features, Risk Factors for Multiresistance and Mortality in a Chinese University Hospital

Ye, Y.; Li, J. B.; Ye, D. Q.; Jiang, Zhiyi

doi:10.1007/s15010-006-5038-3

Cited by 34 publications

(33 citation statements)

References 18 publications

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“…In Taiwan, several observational studies have described the increasing prevalence of ESBLproducing E. cloacae strains, and some reports demonstrated the outbreak and dissemination of these organisms and emphasized that they are an emerging problem, especially in ICUs (26)(27)(28). During the 8-year study period, the prevalence of E. cloacae bacteremic isolates harboring an ESBL gene was 22.6%, similar to that in another report from central Taiwan (28).…”

Section: Discussionmentioning

confidence: 99%

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: Discussionmentioning

confidence: 99%

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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“…First, host- and healthcare-related risk factors for the development of BSI- Ecl are often not considered. Second, the treatment success of various antimicrobials, in particular the association with minimum inhibitory concentration (MIC) values, is usually unreported [12–15]. Finally, the links between the molecular characterisation of isolates, the treatment paradigm and their outcome are lacking.…”

Section: Introductionmentioning

confidence: 99%

Characterisation and clinical features of Enterobacter cloacae bloodstream infections occurring at a tertiary care university hospital in Switzerland: is cefepime adequate therapy?

Hilty

Sendi

Seiffert

et al. 2013

International Journal of Antimicrobial Agents

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Despite many years of clinical experience with cefepime, data regarding the outcome of patients suffering from bloodstream infections (BSIs) due to Enterobacter cloacae (Ecl) are scarce. To address the gap in our knowledge, 57 Ecl responsible for 51 BSIs were analysed implementing phenotypic and molecular methods (microarrays, PCRs for bla and other genes, rep-PCR to analyse clonality). Only two E. cloacae (3.5%) were ESBL-producers, whereas 34 (59.6%) and 18 (31.6%) possessed inducible (Ind-Ecl) or derepressed (Der-Ecl) AmpC enzymes, respectively. All isolates were susceptible to imipenem, meropenem, gentamicin and ciprofloxacin. Der-Ecl were highly resistant to ceftazidime and piperacillin/tazobactam (both MIC90 ≥ 256 µg/mL), whereas cefepime retained its activity (MIC90 of 3 µg/mL). rep-PCR indicated that the isolates were sporadic, but Ecl collected from the same patients were indistinguishable. In particular, three BSIs initially due to Ind-Ecl evolved (under ceftriaxone or piperacillin/tazobactam treatment) into Der-Ecl because of mutations or a deletion in ampD or insertion of IS4321 in the promoter. These last two mechanisms have never been described in Ecl. Mortality was higher for BSIs due to Der-Ecl than Ind-Ecl (3.8% vs. 29.4%; P = 0.028) and was associated with the Charlson co-morbidity index (P = 0.046). Using the following directed treatments, patients with BSI showed a favourable treatment outcome: cefepime (16/18; 88.9%); carbapenems (12/13; 92.3%); ceftriaxone (4/7; 57.1%); piperacillin/tazobactam (5/7; 71.4%); and ciprofloxacin (6/6; 100%). Cefepime represents a safe therapeutic option and an alternative to carbapenems to treat BSIs due to Ecl when the prevalence of ESBL-producers is low.

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“…Development of resistance is associated with the use of third generation cephalosporins or the prolonged use of perioperative antibiotic prophylaxis [2]. Other risk factors for colonization or infection with multiresistant bacteria such as Enterobacteriaceae with production of extended-spectrum betalactamases include the presence of an indwelling urinary catheter or residence in a nursing home [3].…”

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confidence: 99%

Antibiotic Resistance – Running Out of Treatment Options

Ruef¹

2007

Infection

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Enterobacter Bacteremia: Clinical Features, Risk Factors for Multiresistance and Mortality in a Chinese University Hospital

Cited by 34 publications

References 18 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

Characterisation and clinical features of Enterobacter cloacae bloodstream infections occurring at a tertiary care university hospital in Switzerland: is cefepime adequate therapy?

Antibiotic Resistance – Running Out of Treatment Options

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