Bacteremia due to extended-spectrum-beta-lactamase-producing Enterobacter cloacae: role of carbapenem therapy.
Enterobacter cloacae is an important nosocomial pathogen. However, few studies specifically dealing with the clinical characteristics and outcome of extended-spectrum beta-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 beta-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 beta-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.
Lee
Ching-Chi
CC
Department of Emergency Medicine, National Cheng Kung University Hospital, No. 138, Sheng Li Road, 70403, Tainan, Taiwan.
Lee
Nan-Yao
NY
Yan
Jing-Jou
JJ
Lee
Hsin-Chun
HC
Chen
Po-Lin
PL
Chang
Chia-Ming
CM
Wu
Chi-Jung
CJ
Ko
Nai-Ying
NY
Wang
Li-Rong
LR
Chi
Chih-Hsien
CH
Ko
Wen-Chien
WC
D000368:Aged; D000369:Aged, 80 and over; D016470:Bacteremia / Q000188:drug therapy* / Q000382:microbiology*; D015780:Carbapenems / Q000627:therapeutic use*; D016972:Enterobacter cloacae / Q000187:drug effects / Q000378:metabolism* / Q000472:pathogenicity*; D006801:Humans; D008875:Middle Aged; D012189:Retrospective Studies; D001618:beta-Lactamases / Q000378:metabolism*
D015780:Carbapenems; D001618:beta-Lactamases