title: Risk factors and outcome of extended-spectrum β-lactamase-producing Enterobacter cloacae bloodstream infections.
abstract: Enterobacter cloacae is a major nosocomial pathogen that causes serious infections, including bloodstream infections (BSIs). The clinical significance of extended-spectrum β-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 96 h 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.
authors.affiliation: Division of Infectious Diseases, University of Pittsburgh Medical Center, 200 Lothrop Street, Pittsburgh, PA 15213, USA.
authors.forename: Zubair A
authors.initials: ZA
authors.lastname: Qureshi
authors.forename: David L
authors.initials: DL
authors.lastname: Paterson
authors.forename: Diana L
authors.initials: DL
authors.lastname: Pakstis
authors.forename: Jennifer M
authors.initials: JM
authors.lastname: Adams-Haduch
authors.forename: Gabriel
authors.initials: G
authors.lastname: Sandkovsky
authors.forename: Emilia
authors.initials: E
authors.lastname: Sordillo
authors.forename: Bruce
authors.initials: B
authors.lastname: Polsky
authors.forename: Anton Y
authors.initials: AY
authors.lastname: Peleg
authors.forename: Manveen K
authors.initials: MK
authors.lastname: Bhussar
authors.forename: Yohei
authors.initials: Y
authors.lastname: Doi
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D001315:Australia / Q000453:epidemiology; D016470:Bacteremia / Q000188:drug therapy* / Q000453:epidemiology* / Q000382:microbiology; D015373:Bacterial Typing Techniques; D015331:Cohort Studies; D003428:Cross Infection / Q000188:drug therapy / Q000453:epidemiology / Q000382:microbiology; D016972:Enterobacter cloacae / Q000187:drug effects / Q000201:enzymology* / Q000302:isolation & purification; D004756:Enterobacteriaceae Infections / Q000188:drug therapy* / Q000453:epidemiology* / Q000382:microbiology; D005260:Female; D005838:Genotype; D006801:Humans; D008297:Male; D017720:Molecular Epidemiology; D058889:Molecular Typing; D012189:Retrospective Studies; D012307:Risk Factors; D016896:Treatment Outcome; D001618:beta-Lactamases / Q000096:biosynthesis*
chemical_list: D000900:Anti-Bacterial Agents; D001618:beta-Lactamases