TY - JOUR
T1 - Risk factors and outcome of extended-spectrum beta-lactamase-producing Enterobacter cloacae bloodstream infections
AU - Qureshi, Zubair
AU - Paterson, David
AU - Pakstis, Diana
AU - Adams-Haduch, Jennifer
AU - Sandkovsky, Gabriel
AU - Sordillo, Emilia
AU - Polsky, Bruce
AU - Peleg, Anton
AU - Bhussar, Manveen
AU - Doi, Yohei
PY - 2011
Y1 - 2011
N2 - Enterobacter cloacae is a major nosocomial pathogen that causes serious infections, including bloodstream infections (BSIs). The clinical significance of extended-spectrum beta-lactamase (ESBL) production in E. cloacae is not well established. A multicentre, retrospective, cohort study was conducted to identify clinical characteristics of patients with E. cloacae BSI. ESBL production was confirmed by genotypic methods. A total of 159 patients with E. cloacae BSI were identified at three medical centres in north-eastern USA. Amongst them, 16 patients (10.1 ) harboured ESBL-producing E. cloacae. Independent risk factors for ESBL production included admission from a nursing home, the presence of a gastrostomy tube and history of transplant. For the outcome analysis, 15 consecutive patients who had ESBL-producing E. cloacae BSI prior to the study were included. Amongst the 31 patients with ESBL-producing E. cloacae, 8, 9, 4 and 2 patients received a carbapenem, cefepime, piperacillin/tazobactam and ciprofloxacin, respectively, as initial therapy. All patients who received a carbapenem (n=8) were alive at 28 days, whereas 7 (38.9 ) of 18 patients who received a non-carbapenem antibiotic did not survive (P=0.06). Clinical failure at 96h was observed in 2 (25.0 ) of 8 patients who received a carbapenem and in 14 (77.8 ) of 18 patients who received a non-carbapenem antibiotic (P=0.03). Pulsed-field gel electrophoresis showed little clonality amongst the study isolates. The majority of isolates produced SHV-type ESBL, whereas two isolates produced CTX-M-type ESBL. Initial therapy with a carbapenem appears to be associated with improved clinical outcome in BSI due to ESBL-producing E. cloacae.
AB - Enterobacter cloacae is a major nosocomial pathogen that causes serious infections, including bloodstream infections (BSIs). The clinical significance of extended-spectrum beta-lactamase (ESBL) production in E. cloacae is not well established. A multicentre, retrospective, cohort study was conducted to identify clinical characteristics of patients with E. cloacae BSI. ESBL production was confirmed by genotypic methods. A total of 159 patients with E. cloacae BSI were identified at three medical centres in north-eastern USA. Amongst them, 16 patients (10.1 ) harboured ESBL-producing E. cloacae. Independent risk factors for ESBL production included admission from a nursing home, the presence of a gastrostomy tube and history of transplant. For the outcome analysis, 15 consecutive patients who had ESBL-producing E. cloacae BSI prior to the study were included. Amongst the 31 patients with ESBL-producing E. cloacae, 8, 9, 4 and 2 patients received a carbapenem, cefepime, piperacillin/tazobactam and ciprofloxacin, respectively, as initial therapy. All patients who received a carbapenem (n=8) were alive at 28 days, whereas 7 (38.9 ) of 18 patients who received a non-carbapenem antibiotic did not survive (P=0.06). Clinical failure at 96h was observed in 2 (25.0 ) of 8 patients who received a carbapenem and in 14 (77.8 ) of 18 patients who received a non-carbapenem antibiotic (P=0.03). Pulsed-field gel electrophoresis showed little clonality amongst the study isolates. The majority of isolates produced SHV-type ESBL, whereas two isolates produced CTX-M-type ESBL. Initial therapy with a carbapenem appears to be associated with improved clinical outcome in BSI due to ESBL-producing E. cloacae.
UR - http://www.ncbi.nlm.nih.gov/pubmed/21075605
U2 - 10.1016/j.ijantimicag.2010.09.009
DO - 10.1016/j.ijantimicag.2010.09.009
M3 - Article
SN - 0924-8579
VL - 37
SP - 26
EP - 32
JO - International Journal of Antimicrobial Agents
JF - International Journal of Antimicrobial Agents
IS - 1
ER -