Bloodstream Infections Caused by Enterobacter Species: Predictors of 30-Day Mortality Rate and Impact of Broad-Spectrum Cephalosporin Resistance on Outcome

Abstract

Broad-spectrum cephalosporin resistance adversely affects the outcome of patients with Enterobacter bacteremia, especially those with an unknown primary site of infection and those with septic shock.

Isolation of Imipenem-Resistant Enterobacter Species: Emergence of KPC-2 Carbapenemase, Molecular Characterization, Epidemiology, and Outcomes

“…IRE infections are associated with increased mortality. Enhanced measures to control the hospital spread of IRE are warranted.Enterobacter species are among the most common causes of gram-negative health care-associated infections (12,20,24,28,30,35), causing 8% of nosocomial bacteremia cases, and are the second most common gram-negative pathogens causing pneumonia in patients admitted to intensive care units (ICUs) (19,24,28,30). In addition, in recent years, they are an increasing cause of community-acquired infections as well (30).…”

“…Resistance to ␤-lactams is usually mediated through ␤-lactamase production or an alteration of porins, although other mechanisms such as target site modifications (e.g., in penicillin binding proteins) and drug efflux pumps have also been reported (35). Risk factors for Enterobacter infections and for extended-spectrum cephalosporin-resistant Enterobacter infections have been extensively investigated in the past (11,13,20,21,30). These resistant pathogens pose a major therapeutic challenge and are associated with treatment failures, which lead to increased mortality, morbidity, and cost (10,20,28,30,33).…”

“…Risk factors for Enterobacter infections and for extended-spectrum cephalosporin-resistant Enterobacter infections have been extensively investigated in the past (11,13,20,21,30). These resistant pathogens pose a major therapeutic challenge and are associated with treatment failures, which lead to increased mortality, morbidity, and cost (10,20,28,30,33).Carbapenems are the most potent ␤-lactam antibiotics (2, 14, 27) and are the most reliable ␤-lactams for the treatment of serious infections caused by resistant Enterobacter strains (14,27,28,33,35). The carbapenem group is considered the class of last resort against resistant Enterobacteriaceae.…”

“…Resistance to a variety of broad-spectrum antimicrobials among Enterobacter strains, including ␤-lactams, is frequently encountered (20,26,35). Moreover, the emergence of resistance to extended-spectrum cephalosporins occurs often during therapy (8).…”

Failure To Control an Outbreak of qnrA1 -Positive Multidrug-Resistant Enterobacter cloacae Infection despite Adequate Implementation of Recommended Infection Control Measures

“…Although in the past most reports described outbreaks that were confined to one ward or hospital, in recent years outbreaks have increasingly been reported to involve multiple health care facilities (e.g., other hospitals, nursing homes, and rehabilitation centers) (1,4,5,12,15,36,37). Infections with MRE lead to higher morbidity and mortality among affected patients and increase the hospital costs substantially (16,18). Furthermore, most of these strains carry conjugative R plasmids that are easily transferred to other species, increasing the antimicrobial resistance problems in health care facilities (21,22,26,28).…”