Risk factors and outcome of extended-spectrum β-lactamase-producing Enterobacter cloacae bloodstream infections

Zubair A. Qureshi, David L. Paterson, Diana L. Pakstis, Jennifer M. Adams-Haduch, Gabriel Sandkovsky, Emilia Sordillo, Bruce Polsky, Anton Y. Peleg, Manveen K. Bhussar, Yohei Doi

Research output: Contribution to journalArticle

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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.

Original languageEnglish
Pages (from-to)26-32
Number of pages7
JournalInternational Journal of Antimicrobial Agents
Volume37
Issue number1
DOIs
Publication statusPublished - 01-01-2011

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Enterobacter cloacae
Infection
Carbapenems
Anti-Bacterial Agents
Gastrostomy
Pulsed Field Gel Electrophoresis
Ciprofloxacin
Nursing Homes
Cohort Studies
Retrospective Studies
Transplants

All Science Journal Classification (ASJC) codes

  • Microbiology (medical)
  • Infectious Diseases
  • Pharmacology (medical)

Cite this

Qureshi, Zubair A. ; Paterson, David L. ; Pakstis, Diana L. ; Adams-Haduch, Jennifer M. ; Sandkovsky, Gabriel ; Sordillo, Emilia ; Polsky, Bruce ; Peleg, Anton Y. ; Bhussar, Manveen K. ; Doi, Yohei. / Risk factors and outcome of extended-spectrum β-lactamase-producing Enterobacter cloacae bloodstream infections. In: International Journal of Antimicrobial Agents. 2011 ; Vol. 37, No. 1. pp. 26-32.
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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.",
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Qureshi, ZA, Paterson, DL, Pakstis, DL, Adams-Haduch, JM, Sandkovsky, G, Sordillo, E, Polsky, B, Peleg, AY, Bhussar, MK & Doi, Y 2011, 'Risk factors and outcome of extended-spectrum β-lactamase-producing Enterobacter cloacae bloodstream infections', International Journal of Antimicrobial Agents, vol. 37, no. 1, pp. 26-32. https://doi.org/10.1016/j.ijantimicag.2010.09.009

Risk factors and outcome of extended-spectrum β-lactamase-producing Enterobacter cloacae bloodstream infections. / Qureshi, Zubair A.; Paterson, David L.; Pakstis, Diana L.; Adams-Haduch, Jennifer M.; Sandkovsky, Gabriel; Sordillo, Emilia; Polsky, Bruce; Peleg, Anton Y.; Bhussar, Manveen K.; Doi, Yohei.

In: International Journal of Antimicrobial Agents, Vol. 37, No. 1, 01.01.2011, p. 26-32.

Research output: Contribution to journalArticle

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T1 - Risk factors and outcome of extended-spectrum β-lactamase-producing Enterobacter cloacae bloodstream infections

AU - Qureshi, Zubair A.

AU - Paterson, David L.

AU - Pakstis, Diana L.

AU - Adams-Haduch, Jennifer M.

AU - Sandkovsky, Gabriel

AU - Sordillo, Emilia

AU - Polsky, Bruce

AU - Peleg, Anton Y.

AU - Bhussar, Manveen K.

AU - Doi, Yohei

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Y1 - 2011/1/1

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AB - 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.

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