Table 4.
Clinical characteristics, antimicrobial regimens and treatment outcome for bloodstream infection (BSI) cases due to Enterobacter cloacae (Ecl) isolates with inducible AmpC phenotype (Ind-Ecl).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) |
|||||||||
| 1 | 66/M | Pancreatic Ca (abdominal surgery) | UF, 13 | Severe sepsis | (UTI) | ≥90/≥90 | CRO (4) | AMC (4 days after); CIP (4 days after) | 625 mg × 3 (11); 500 mg × 2 (11) | PR |
| 2 | 63/M | Gallbladder Ca (abdominal surgery) | UF, 11 | Severe sepsis | (UTI) | ≥90/55 | IPM | Unchanged (20 days before) | 500 mg × 4 (37) | CR |
| 4 | 51/F | Neutropenic fever, AML (oncology) | UF, 2 | Sepsis | (Neutropenic colitis) | ≥90/≥90 | AMC (17), CIP (17) | FEP (1 day after); CIP (5 days after) | 2 g × 3 (5); 500 mg × 2 (10) | PR (new BSI, see #43) |
| 6 | 44/F | Subarachnoid bleeding (neurosurgery) | NF, 3 | Sepsis | (Cholangiosepsis) | ≥90/≥90 | TZP (1), CRO (1) | FEP (2 days after) | 1 g × 3 (14) | CR (ESBL-Ecl) |
| 7 | 60/F | Ureteral Ca (urology) | UF, 6 | Sepsis | UTI, IVC | ≥90/50 | AMC (4), TOB (4) | CIP (4 days after) | 500 mg × 2 (20) | CR |
| 8 | 50/M | ALL (oncology) | UF, 3 | Sepsis | UTI | 71/79 | FEP | Unchanged (first day) | 1 g × 3 (15) | CR |
| 9 | 60/M | Polytrauma (ICU) | NF, 0 | Sepsis | (Wound infection) | PH/21 | SXT (1), FEP | FEP (first day) | 1 g × 2 (8) | PR |
| 10 | 50/M | ALL (oncology) | UF, 2 | Sepsis | (Neutropenic colitis) | 51/86 | FEP | Unchanged (first day) | 1 g × 3 (22) | CR |
| 11 | 57/M | ALL (oncology) | UF, 3 | Sepsis | Unknown | ≥90/86 | FEP (3) | CRO (4 days after) | 2 g × 1 (7) | CR |
| 12 | 51/M | Polytrauma (ICU) | NF, 0 | Severe sepsis | Unknown | PH/24 | TZP | Unchanged (first day) | 2.25 g × 4 (9) | CR |
| 13 | 70/M | Cardiogenic shock (vascular surgery) | NF, 5 | Sepsis | (Central venous catheter) | 53/35 | MEM (3) | FEP (4 days after) | 1 g × 3 (8) | CR |
| 14 | 55/M | Cardiogenic shock (vascular surgery) | NF, 3 | Sepsis | (UTI) | NA/64 | CRO | Unchanged (first day) | 2 g × 1 (11) | CR |
| 15 | 74/F | Neutropenic fever (oncology) | UF, 4 | Sepsis | (Neutropenic colitis) | 88/85 | FEP | Unchanged (first day) | 2 g × 3 (12) | PR |
| 17 | 39/M | AML (oncology) | UF, 2 | Sepsis | Unknown | ≥90/≥90 | FEP | Unchanged (first day) | 1 g × 3 (20) | CR |
| 18 | 44/F | AML (oncology) | UF, 2 | Sepsis | UTI | PH/≥90 | FEP (3) | TZP (3 days after) | 4.5 mg × 3 (4) | PR |
| 19 | 67/F | Vaginal Ca (abdominal surgery) | UF, 3 | Severe sepsis | (Fistula in small intestine) | ≥90/61 | IPM, TOB | Unchanged (first day) | 1 g × 3 (9); 5 mg/kg × 1 (1) | Relapse |
| 20 | 67/M | Polytrauma (orthopaedic) | NF, 0 | Sepsis | (Cholecystitis) | PH/≥90 | CRO (2) | FEP (3 days after); MEM (7 days after) | 1 g × 3 (4); 1 g × 3 (28) | CR |
| 21 | 68/M | Lung Ca (medicine) | RF, 8 | Sepsis | Unknown | 79/≥90 | AMC (7) | CRO (1 day after) | 2 g × 1 (9) | Failure (death 22 days after BSI onset) |
| 24 | 75/M | Urosepsis, prostate Ca (urology) | NF, 4 | Severe sepsis | UTI | 48/38 | CRO | Unchanged (first day) | 2 g × 1 (4) | CR |
| 25 | 73/M | Choledocolithiasis (ICU) | NF, 5 | Sepsis | (Cholangiosepsis) | 51/26 | CRO (1) | TZP (2 days after) | 4.5 g × 3 (4) | PR |
| 27 | 70/M | Heart bypass (ICU) | NF, NA | Sepsis | IVC | 65/27 | FEP | Unchanged (first day) | 2 g × 1 (14) | CR |
| 28 | 27/M | Acute appendicitis (abdominal surgery) | NF, 0 | Sepsis | (Appendicitis) | ≥90/≥90 | AMC (1) | CIP (3 days after) | 500 mg × 2 (6) | CR |
| 29 | 65/F | Hepatic Ca (abdominal surgery) | UF, 13 | Sepsis | Unknown | 68/30 | TZP | Unchanged (first day) | 4.5 g × 3 (13) | CR |
| 36 | 59/M | Lung Ca, pneumonia (medicine) | UF, 7 | Sepsis | (LRTI) | ≥90/≥90 | FEP | Unchanged (first day) | 1 g × 3 (10) | CR |
| 38 | 49/M | AML (oncology) | UF, 2 | Sepsis | UTI | ≥90/≥90 | MEM (2) | FEP (3 days after) | 2 g × 3 (10) | CR |
| 40 | 62/M | Neutropenic fever (abdominal surgery) | NF, 1 | Sepsis | (Cholangiosepsis) | ≥90/≥90 | CRO (7) | CIP (8 days after) | 500 mg × 2 (15) | CR |
| 42 | 44/M | Fever, T-cell lymphoma (oncology) | UF, 2 | Sepsis | Unknown | ≥90/≥90 | FEP (NA) | MEM (NA) | NA, NA | CR |
| p48 | 8/M | Severe aplastic anaemia (paediatric) | RF, 0 | na | Unknown | na | MEM (4) | CRO (4 days after) | NA (7) | PR (new BSI, see #p49) |
| p49 | – | – | – | na | Unknown | na | CRO (5), AMK (10) | MEM (1 day after); CIP (5 days after) | NA (11); NA (7) | CR |
ID, identification; AST, antimicrobial susceptibility test; Ca, carcinoma; AML, acute myeloid leukaemia; ALL, acute lymphoblastic leukaemia; ICU, Intensive Care Unit; UF, ultimately fatal; NF, non-fatal; RF, rapidly fatal; na, not applicable; UTI, urinary tract infection; IVC, intravascular catheter colonisation; LRTI, lower respiratory tract infection; PH, previously healthy; NA, not available; CRO, ceftriaxone; IPM, imipenem; AMC, amoxicillin/clavulanic acid; CIP, ciprofloxacin; TZP, piperacillin/tazobactam; TOB, tobramycin; FEP, cefepime; SXT, trimethoprim/sulfamethoxazole; MEM, meropenem; AMK, amikacin; PR, partial response; CR, complete response; ESBL, extended-spectrum β-lactamase.
BSI cases initially due to Ind-Ecl but then evolving to derepressed Ecl (Der-Ecl) (5, 30 and p45) and those simultaneously having Ind-Ecl and Der-Ecl strains (3, 26 and 31) are included only in Table 3.
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 lowest value within 7 days from date of BSI).