Bacteremia due to extended-spectrum-β-lactamase-producing Enterobacter cloacae: Role of carbapenem therapy

Ching Chi Lee, Nan Yao Lee, Jing Jou Yan, Hsin Chun Lee, Po Lin Chen, Chia Ming Chang, Chi Jung Wu, Nai Ying Ko, Li Rong Wang, H. Hsien Chi, Wen Chien Ko

Research output: Contribution to journalArticle

38 Citations (Scopus)

Abstract

Enterobacter cloacae is an important nosocomial pathogen. However, few studies specifically dealing with the clinical characteristics and outcome of extended-spectrum β-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 blaSHV-12 gene, 3 (2.1%) had bla CTX-M3, and 2 (1.4%) had both the blaSHV-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 β-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 β-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.

Original languageEnglish
Pages (from-to)3551-3556
Number of pages6
JournalAntimicrobial agents and chemotherapy
Volume54
Issue number9
DOIs
Publication statusPublished - 2010 Sep 1

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Enterobacter cloacae
Carbapenems
Bacteremia
Lactams
Therapeutics
Genes
Intensive Care Units
Sepsis
Control Groups
Cefotaxime
Mortality
Length of Stay
Multivariate Analysis
Phenotype
Infection

All Science Journal Classification (ASJC) codes

  • Pharmacology
  • Pharmacology (medical)
  • Infectious Diseases

Cite this

@article{c38d51d2ce4b43a38c3774ce28460d13,
title = "Bacteremia due to extended-spectrum-β-lactamase-producing Enterobacter cloacae: Role of carbapenem therapy",
abstract = "Enterobacter cloacae is an important nosocomial pathogen. However, few studies specifically dealing with the clinical characteristics and outcome of extended-spectrum β-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 blaSHV-12 gene, 3 (2.1{\%}) had bla CTX-M3, and 2 (1.4{\%}) had both the blaSHV-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 β-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 β-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.",
author = "Lee, {Ching Chi} and Lee, {Nan Yao} and Yan, {Jing Jou} and Lee, {Hsin Chun} and Chen, {Po Lin} and Chang, {Chia Ming} and Wu, {Chi Jung} and Ko, {Nai Ying} and Wang, {Li Rong} and Chi, {H. Hsien} and Ko, {Wen Chien}",
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}

Bacteremia due to extended-spectrum-β-lactamase-producing Enterobacter cloacae : Role of carbapenem therapy. / Lee, Ching Chi; Lee, Nan Yao; Yan, Jing Jou; Lee, Hsin Chun; Chen, Po Lin; Chang, Chia Ming; Wu, Chi Jung; Ko, Nai Ying; Wang, Li Rong; Chi, H. Hsien; Ko, Wen Chien.

In: Antimicrobial agents and chemotherapy, Vol. 54, No. 9, 01.09.2010, p. 3551-3556.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Bacteremia due to extended-spectrum-β-lactamase-producing Enterobacter cloacae

T2 - Role of carbapenem therapy

AU - Lee, Ching Chi

AU - Lee, Nan Yao

AU - Yan, Jing Jou

AU - Lee, Hsin Chun

AU - Chen, Po Lin

AU - Chang, Chia Ming

AU - Wu, Chi Jung

AU - Ko, Nai Ying

AU - Wang, Li Rong

AU - Chi, H. Hsien

AU - Ko, Wen Chien

PY - 2010/9/1

Y1 - 2010/9/1

N2 - Enterobacter cloacae is an important nosocomial pathogen. However, few studies specifically dealing with the clinical characteristics and outcome of extended-spectrum β-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 blaSHV-12 gene, 3 (2.1%) had bla CTX-M3, and 2 (1.4%) had both the blaSHV-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 β-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 β-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.

AB - Enterobacter cloacae is an important nosocomial pathogen. However, few studies specifically dealing with the clinical characteristics and outcome of extended-spectrum β-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 blaSHV-12 gene, 3 (2.1%) had bla CTX-M3, and 2 (1.4%) had both the blaSHV-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 β-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 β-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.

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