title: Nosocomial outbreak due to extended-spectrum-beta-lactamase- producing Enterobacter cloacae in a cardiothoracic intensive care unit.
abstract: Enterobacter cloacae has been associated with several outbreaks, usually involving strains that overproduce chromosomal beta-lactamase or, uncommonly, strains expressing extended-spectrum beta-lactamases (ESBL). Only sporadic cases of ESBL-producing E. cloacae have been identified in our hospital in recent years. We describe the epidemiology and clinical and microbiological characteristics of an outbreak caused by ESBL-producing E. cloacae in a cardiothoracic intensive care unit (CT-ICU). Prospective surveillance of patients with infection or colonization by ESBL-producing E. cloacae among patients admitted to the CT-ICU was performed during the outbreak. Production of ESBL was determined by decreased susceptibility to expanded-spectrum cephalosporins and a positive double-disk test result. Clone relatedness was determined by pulsed-field gel electrophoresis (PFGE). From July to September 2005, seven patients in the CT-ICU with ESBL-producing E. cloacae were identified (four males; median age, 73 years; range, 45 to 76 years); six patients had cardiac surgery. Four patients developed infections; three had primary bacteremia, one had ventilator-associated pneumonia, and one had tracheobronchitis. ESBL-producing E. cloacae showed resistance to quinolones and aminoglycosides. PFGE revealed two patterns. Five isolates belonged to clone A; two carried a single ESBL (pI 8.2 and a positive PCR result for the SHV type), and three carried two ESBLs (pIs 8.1 and 8.2 and positive PCR results for the SHV and CTX-M-9 types). Isolates belonging to clone B carried a single ESBL (pI 5.4 and a positive PCR result for the TEM type). Review of antibiotic consumption showed increased use of cefepime and quinolones during June and July 2005. The outbreak was stopped by the implementation of barrier measures and cephalosporin restriction. ESBL production could be increasingly common in nosocomial pathogens other than Escherichia coli or Klebsiella pneumoniae.
authors.affiliation: Infectious Diseases Service, Hospital Universitari de Bellvitge, Feixa Llarga, sn., L'Hospitalet de Llobregat, 08907 Barcelona, Spain. admanzur@yahoo.com.ar
authors.forename: Adriana
authors.initials: A
authors.lastname: Manzur
authors.forename: Fe
authors.initials: F
authors.lastname: Tubau
authors.forename: Miquel
authors.initials: M
authors.lastname: Pujol
authors.forename: Laura
authors.initials: L
authors.lastname: Calatayud
authors.forename: Maria Angeles
authors.initials: MA
authors.lastname: Dominguez
authors.forename: Carmen
authors.initials: C
authors.lastname: Peña
authors.forename: Mercedes
authors.initials: M
authors.lastname: Sora
authors.forename: Francesc
authors.initials: F
authors.lastname: Gudiol
authors.forename: Javier
authors.initials: J
authors.lastname: Ariza
mesh_terms: D000368:Aged; D000900:Anti-Bacterial Agents / Q000494:pharmacology; D003325:Coronary Care Units; D003428:Cross Infection / Q000453:epidemiology / Q000382:microbiology*; D016172:DNA Fingerprinting; D004269:DNA, Bacterial / Q000235:genetics; D004196:Disease Outbreaks; D016521:Electrophoresis, Gel, Pulsed-Field; D016972:Enterobacter cloacae / Q000145:classification / Q000187:drug effects / Q000201:enzymology* / Q000302:isolation & purification; D004756:Enterobacteriaceae Infections / Q000453:epidemiology / Q000382:microbiology*; D005260:Female; D005838:Genotype; D006801:Humans; D008297:Male; D008826:Microbial Sensitivity Tests; D008875:Middle Aged; D013030:Spain; D001618:beta-Lactamases / Q000096:biosynthesis*
chemical_list: D000900:Anti-Bacterial Agents; D004269:DNA, Bacterial; D001618:beta-Lactamases