Table 3.
Clinical characteristics, antimicrobial regimens and treatment outcome for patients with bloodstream infection (BSI) due to Enterobacter cloacae (Ecl) isolates with derepressed AmpC (Der-Ecl) and those with unidentified phenotypes.a
| No. | Age (years)/sex |
Admitted for (ward) |
McCabe– Jackson class, Charlson index |
Severity of septicaemia |
Primary source of BSIb |
eGFR prior/during BSI (mL/min)c |
Empirical treatment (total days) |
Therapy administered after ID/AST results |
Treatment outcome (comments) |
|
|---|---|---|---|---|---|---|---|---|---|---|
| Agent (timing from BSI onset) |
Daily dose (total days) |
|||||||||
| 3-A/-B | 65/M | AML (oncology) | UF, 4 | Sepsis | (Neutropenic colitis) | ≥90/≥90 | FEP (12) | MEM (1 day after) | 1 g × 3 (10) | PR (death 11 days after BSI) |
| 5-I | 71/F | Aortic valve stenosis (nephrology) | NF, 5 | Septic shock | Unknown | NA/<10 | MEM (5) | TZP (2 days after) | NA (11) | Failure (Ind-Ecl evolved to Der-Ecl after 3 days, see #5-II) |
| 5-II | – | – | – | – | – | <10 | – | FEP (13 days after) | 2 g × 2 (4) | Relapse (death 17 days after the first BSI) |
| 16 | 64/F | Breast Ca (oncology) | UF, 10 | Sepsis | Unknown | ≥90/≥90 | AMC | AMC (25 days before) | 625 mg × 3 (43) | Not assessable |
| 22 | 74/M | Rupture AAA (vascular surgery) | NF, 4 | Sepsis | (Infected vascular prosthesis) | 57/<10 | CFZ (1) | MEM (1 day after) | 1 g × 1 (30) | CR |
| 23 | 70/F | Valve replacement (vascular surgery/ICU) | NF, 3 | Severe sepsis | LRTI, IVC | 78/≥90 | FEP | Unchanged (11 days before) | 2 g × 3 (31) | Failure (ESBL-Ecl; death 69 days after BSI) |
| 26-A/-B | 85/M | Endocarditis (medicine) | NF, 4 | Sepsis | (Endocarditis) | 30/18 | CRO | Unchanged (1 day before) | 2 g × 1 (18) | Failure (both Ind-Ecl and Der-Ecl; death 18 days after BSI) |
| 30-I | 26/F | Gastroparesis (abdominal surgery) | NF, 0 | Sepsis | IVC | PH | AMC (1); TZP (1) | CRO (2 days after) | 2 g × 1 (5) | Failure (Ind-Ecl evolved to Der-Ecl after 6 days, see #30-II) |
| 30-II | – | – | – | – | – | ≥90/≥90 | TZP (2) | MEM (3 days after) | 2 g × 3 (13) | CR |
| 31-A/-B | 78/M | Valve replacement (vascular surgery) | NF, 5 | Severe sepsis | (Colitis) | 55/22 | FEP (3) | MEM (3 days after) | 1 g × 3 (17) | CR (both Ind-Ecl and Der-Ecl) |
| 32 | 41/F | Haemoptysis, fever (medicine) | NF, 7 | Sepsis | (IVC) | 15/13 | FEP (1) | MEM (4 days after) | 1 g × 3 (6) | CR |
| 33 | 81/M | Wound infection, PAVD (vascular surgery) | NF, 6 | Sepsis | (Central venous catheter) | 68/55 | FEP | Unchanged (first day) | 2 g × 1 (10) | Not assessable |
| 37 | 64/F | Cardiac decompensation (nephrology) | NF, 7 | Sepsis | UTI | 10/23 | CAZ (4) | CIP (5 days after) | NA (9) | CR |
| 39 | 57/F | Stromal tumour, sepsis (medicine) | UF, 11 | Severe sepsis | (Small intestine) | 61/45 | FEP (4) | CIP (4 days after) | 750 mg × 2 (6) | PR (death 17 days after the first BSI) |
| 43 | 51/F | Neutropenic fever, AML (oncology) | UF, 2 | Sepsis | (Neutropenic colitis) | ≥90/≥90 | FEP (41) | MEM (first day) | 2 g × 3 (3) | PR (previous BSI due to Ind-Ecl, see #4) |
| 44 | 33/F | Pre-eclampsia (gynaecology) | NF, 0 | Severe sepsis | (UTI) | ≥90/44 | AMC (1); FEP (2) | MEM (3 days after) | 1 g × 3 (3) | CR |
| p45-I | <1/M | Pyelonephritis (paediatric surgery) | NF, NA | na | UTI | na | CRO (2) | FEP (3 days after) | NA (4) | CR (Ind-Ecl evolved to Der-Ecl after 8 days, see #p45-II) |
| p45-II | – | Persistent UTIs (paediatric) | – | na | UTI | na | None | SXT (first day) | NA (NA) | Not assessable |
| 46 | 81/M | Abdominal abscess (ICU) | NF, 1 | Severe sepsis | (Abdominal abscess) | ≥90/84 | TZP | Unchanged (first day) | 4.5 g × 3 (14) | PR |
| 47 | 64/F | ALL (oncology) | UF, 2 | Sepsis | Unknown | 89/42 | FEP | Unchanged (first day) | 2 g × 3 (46) | PR |
| 50 | 63/F | AML (oncology) | UF, 2 | Sepsis | (Neutropenic colitis) | 80/86 | FEP (4) | MEM (4 days after) | 1 g × 3 (25) | CR |
| 51 | 62/F | Pancreatic Ca (abdominal surgery) | UF, 8 | Severe sepsis | (Cholangiosepsis) | 88/21 | TZP | Unchanged (9 days before) | 4.5 g × 3 (16) | Failure (transferred to LTCF; death in a few days because of BSI) |
| 34d | 62/F | AML (oncology) | UF, 2 | Severe sepsis | (Neutropenic colitis) | ≥90/≥90 | FEP | Unchanged (first day) | 2 g × 3 (25) | CR |
| 35d | 33/M | AML (oncology) | UF, 2 | Sepsis | (Neutropenic colitis) | ≥90/≥90 | FEP | Unchanged (first day) | 2 g × 3 (6) | CR |
| p41d | <1/F | Fever, intestinal ataxia (paediatric) | NF, 0 | NA | (Colitis) | na | FEP (5) | MEM (5 days after) | 35 mg/kg × 3 (12) | CR |
ID, identification; AST, antimicrobial susceptibility test; AML, acute myeloid leukaemia; Ca, carcinoma; AAA, abdominal aortic aneurysm; ICU, Intensive Care Unit; PAVD, peripheral arterial vascular disease; UTI, urinary tract infection; ALL, acute lymphoblastic leukaemia; UF, ultimately fatal; NF, non-fatal; NA, not available; na, not applicable; LRTI, lower respiratory tract infection; IVC, intravascular catheter colonisation; PH, previously healthy; FEP, cefepime; MEM, meropenem; AMC, amoxicillin/clavulanic acid; CFZ, cefazolin; CRO, ceftriaxone; TZP, piperacillin/tazobactam; CAZ, ceftazidime; CIP, ciprofloxacin; SXT, trimethoprim/sulfamethoxazole; PR, partial response; CR, complete response; ESBL, extended-spectrum β-lactamase; LTCF, long-term care facility.
BSI cases initially due to inducible Ecl (Ind-Ecl) but then evolving to Der-Ecl (5, 30 and p45) and those simultaneously having Ind-Ecl and Der-Ecl strains (3, 26 and 31) were included only in this table.
Primary sources based only on clinical suspicion (and not culture results) are reported in parentheses.
Estimated glomerular filtration rate (eGFR) prior to BSI (defined as closest measurement within 14 days) and during sepsis (defined as lowest value within 7 days from date of BSI onset).
The three cases of BSI due to unidentified (i.e. non-inducible and non-derepressed) Ecl isolates are also presented in this table.