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

研究成果: Article査読

56 被引用数 (Scopus)

抄録

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.

本文言語English
ページ(範囲)26-32
ページ数7
ジャーナルInternational Journal of Antimicrobial Agents
37
1
DOI
出版ステータスPublished - 01-2011
外部発表はい

All Science Journal Classification (ASJC) codes

  • 微生物学(医療)
  • 感染症
  • 薬理学(医学)

フィンガープリント

「Risk factors and outcome of extended-spectrum β-lactamase-producing Enterobacter cloacae bloodstream infections」の研究トピックを掘り下げます。これらがまとまってユニークなフィンガープリントを構成します。

引用スタイル