title: Emergence of extended-spectrum β-lactamase producing Enterobacter spp. in patients with bacteremia in a tertiary hospital in southern Brazil.
abstract: BACKGROUND
  Extended-spectrum β-lactamases (ESBLs) are increasingly prevalent in Enterobacter spp., posing a challenge to the treatment of infections caused by this microorganism. The purpose of this retrospective study was to evaluate the prevalence, risk factors, and clinical outcomes of inpatients with bacteremia caused by ESBL and non ESBL-producing Enterobacter spp. in a tertiary hospital over the period 2004-2008.
  
  
  METHODS
  The presence of blaCTX-M, blaTEM, blaSHV, and blaPER genes was detected by polymerase chain reaction (PCR) and nucleotide sequence analysis. Genetic similarity between strains was defined by pulsed-field gel electrophoresis (PFGE).
  
  
  RESULTS
  Enterobacter spp. was identified in 205 of 4907 of the patients who had positive blood cultures during hospitalization. Of those cases, 41 (20%) were ESBL-producing Enterobacter spp. Nosocomial pneumonia was the main source of bacteremia caused by ESBL-producing Enterobacter spp. The presence of this microorganism was associated with longer hospital stays. The ESBL genes detected were: CTX-M-2 (23), CTX-M-59 (10), CTX-M-15 (1), SHV-12 (5), and PER-2 (2). While Enterobacter aerogenes strains showed mainly a clonal profile, Enterobacter cloacae strains were polyclonal.
  
  
  CONCLUSIONS
  Although no difference in clinical outcomes was observed between patients with infections by ESBL-producing and non-ESBL-producing strains, the detection of ESBL in Enterobacter spp. resulted in the change of antimicrobials in 75% of cases, having important implications in the decision-making regarding adequate antimicrobial therapy.
authors.affiliation: Clinics Hospital, Federal University of Paraná (UFPR), Curitiba, Brazil; Postgraduate Program in Pharmaceutical Sciences of UFPR, Curitiba, Brazil.
authors.forename: Keite da Silva
authors.initials: Kda S
authors.lastname: Nogueira
authors.affiliation: Clinics Hospital, Federal University of Paraná (UFPR), Curitiba, Brazil.
authors.forename: Maria Cristina
authors.initials: MC
authors.lastname: Paganini
authors.affiliation: Medical Course of UFPR, Curitiba, Brazil.
authors.forename: Andréia
authors.initials: A
authors.lastname: Conte
authors.affiliation: Clinics Hospital, Federal University of Paraná (UFPR), Curitiba, Brazil.
authors.forename: Laura Lúcia
authors.initials: LL
authors.lastname: Cogo
authors.affiliation: Clinics Hospital, Federal University of Paraná (UFPR), Curitiba, Brazil; Postgraduate Program in Pharmaceutical Sciences of UFPR, Curitiba, Brazil.
authors.forename: Iara
authors.initials: I
authors.lastname: Taborda de Messias Reason
authors.affiliation: Plant Molecular Biology and Genomics of Campinas University (Unicamp), Campinas, Brazil.
authors.forename: Márcio José
authors.initials: MJ
authors.lastname: da Silva
authors.affiliation: Clinics Hospital, Federal University of Paraná (UFPR), Curitiba, Brazil; Pelé Pequeno Príncipe Faculty and Research Institute (FPP/IPPPP), Curitiba, Brazil. Electronic address: lmdc@ufpr.br.
authors.forename: Libera Maria
authors.initials: LM
authors.lastname: Dalla-Costa
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016470:Bacteremia / Q000188:drug therapy / Q000453:epidemiology / Q000382:microbiology*; D001426:Bacterial Proteins / Q000032:analysis* / Q000235:genetics; D001938:Brazil / Q000453:epidemiology; D002648:Child; D002675:Child, Preschool; D004754:Enterobacter / Q000201:enzymology* / Q000235:genetics / Q000302:isolation & purification; D004756:Enterobacteriaceae Infections / Q000188:drug therapy / Q000453:epidemiology / Q000382:microbiology*; D005260:Female; D005798:Genes, Bacterial; D017052:Hospital Mortality; D006784:Hospitals, Teaching / Q000706:statistics & numerical data; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D012189:Retrospective Studies; D012307:Risk Factors; D013379:Substrate Specificity; D016896:Treatment Outcome; D055815:Young Adult; D018440:beta-Lactam Resistance / Q000235:genetics*; D001618:beta-Lactamases / Q000032:analysis* / Q000235:genetics
chemical_list: D001426:Bacterial Proteins; D001618:beta-Lactamases
keywords: BLEE; Bacteremia; Bacteriemia; Beta-lactamasas de espectro extendido; ESBL; Enterobacter; Extended-spectrum β-lactamase