Clinical and microbiologic characteristics of cefotaxime-non-susceptible Enterobacteriaceae bacteremia: a case control study

Abstract

BackgroundCefotaxime plays an important role in the treatment of patients with bacteremia due to Enterobacteriaceae, although cefotaxime resistance is reported to be increasing in association with extended-spectrum β-lactamase (ESBL) and AmpC β-lactamase (AmpC).MethodsWe conducted a case-control study in a Japanese university hospital between 2011 and 2012. We assessed the risk factors and clinical outcomes of bacteremia due to cefotaxime-non-susceptible Enterobacteriaceae (CTXNS-En) and analyzed the resistance mechanisms.ResultsOf 316 patients with Enterobacteriaceae bacteremia, 37 patients with bacteremia caused by CTXNS-En were matched to 74 patients who had bacteremia caused by cefotaxime-susceptible Enterobacteriaceae (CTXS-En). The most common CTXNS-En was Escherichia coli (43%), followed by Enterobacter spp. (24%) and Klebsiella spp. (22%). Independent risk factors for CTXNS-En bacteremia included previous infection or colonization of CTXNS-En, cardiac disease, the presence of intravascular catheter and prior surgery within 30 days. Patients with CTXNS-En bacteremia were less likely to receive appropriate empirical therapy and to achieve a complete response at 72 h than patients with CTXS-En bacteremia. Mortality was comparable between CTXNS-En and CTXS-En patients (5 vs. 3%). CTXNS-En isolates exhibited multidrug resistance but remained highly susceptible to amikacin and meropenem. CTX-M-type ESBLs accounted for 76% of the β-lactamase genes responsible for CTXNS E. coli and Klebsiella spp. isolates, followed by plasmid-mediated AmpC (12%). Chromosomal AmpC was responsible for 89% of CTXNS Enterobacter spp. isolates.ConclusionsCTXNS-En isolates harboring ESBL and AmpC caused delays in appropriate therapy among bacteremic patients. Risk factors and antibiograms may improve the selection of appropriate therapy for CTXNS-En bacteremia. Prevalent mechanisms of resistance in CTXNS-En were ESBL and chromosomal AmpC.Electronic supplementary materialThe online version of this article (doi:10.1186/s12879-016-2150-6) contains supplementary material, which is available to authorized users.

Beta-Lactam/Beta-Lactamase Inhibitor Therapy for Potential AmpC-Producing Organisms: A Systematic Review and Meta-Analysis

“…One study was excluded from the final analysis due to the absence of events in either treatment arm [13]. Meta-analysis of the 12 remaining studies yielded a pooled OR for death within 30 days for patients receiving a BL/BLI as definitive therapy of 1.04 (95% CI 0.54–2.02).…”

Clinical Impact and Risk Factors of Nonsusceptibility to Third-Generation Cephalosporins Among Hospitalized Adults with Monomicrobial Enterobacteriaceae Bacteremia in Southern Taiwan: A Multicenter Study

“…However, such a result needs to be interpreted with caution, because patients infected by the isolates of antimicrobial-resistant Enterobacteriaceae were older and had more comorbidities. 1 , 26 Moreover, the other explanation for unfavorable prognoses might result from delayed administration of appropriate antibiotics. 18 , 19 Similar to the previous report, 1 inadequate empirical antibiotic therapy was more common in patients with 3GC-NS mEB than in those with bacteremia due to 3GC-susceptible Enterobacteriaceae isolates.…”

Clinical Impact and Risk Factors of Nonsusceptibility to Third-Generation Cephalosporins Among Hospitalized Adults With Monomicrobial Enterobacteriaceae Bacteremia in Southern Taiwan: A Multicenter Study

“…Likewise, several variables, including male gender, age, usage of nasogastric tube, and bacteremic episodes due to K. pneumoniae, were independently linked to 3GC-NS mEB in our cohort. However, some predictors identi ed in previous investigations [1,16,26], such as the presence of an invasive prosthesis or intravascular catheter, recent surgery or hospitalization, or residence in nursing-home or long-term care facility were not assessed in the present retrospective study.…”