Emergence of extended-spectrum beta-lactamase producing Enterobacter spp. in patients with bacteremia in a tertiary hospital in southern Brazil

作者：Nogueira Keite da Silva; Paganini Maria Cristina; Conte Andreia; Cogo Laura Lucia; de Messias Reason Iara Taborda; da Silva Marcio Jose; Dalla Costa Libera Maria^*

来源：Enfermedades Infecciosas y Microbiologia Clinica, 2014, 32(2): 87-92.

DOI：10.1016/j.eimc.2013.02.004

• Bacteremia
• Enterobacter
• Extended-spectrum beta-lactamase
• ESBL

Background: Extended-spectrum beta-lactamases (ESBLs) are increasingly prevalent in Enterobacter spp., posing a challenge to the treatment of infections caused by this microorganism. The purpose of this retrospective study was to evaluate the prevalence, risk factors, and clinical outcomes of inpatients with bacteremia caused by ESBL and non ESBL-producing Enterobacter spp. in a tertiary hospital over the period 2004-2008. %26lt;br%26gt;Methods: The presence of bla(CTX-M), bla(TEM), bla(SHV), and bla(PER) genes was detected by polymerase chain reaction (PCR) and nucleotide sequence analysis. Genetic similarity between strains was defined by pulsed-field gel electrophoresis (PFGE). %26lt;br%26gt;Results: Enterobacter spp. was identified in 205 of 4907 of the patients who ad positive blood cultures during hospitalization. Of those cases, 41(20%) were ESBL-producing Enterobacter spp. Nosocomial pneumonia was the main source of bacteremia caused by ESBL-producing Enterobacter spp. The presence of this microorganism was associated with longer hospital stays. The ESBL genes detected were: CTX-M-2 (23), CTX-M-59 (10), CTX-M-15 (1), SHV-12 (5), and PER-2 (2). While Enterobacter aerogenes strains showed mainly a clonal profile, Enterobacter cloacae strains were polyclonal. %26lt;br%26gt;Conclusion: Although no difference in clinical outcomes was observed between patients with infections by ESBL-producing and non-ESBL-producing strains, the detection of ESBL in Enterobacter spp. resulted in the change of antimicrobials in 75% of cases, having important implications in the decision-making regarding adequate antimicrobial therapy.

• 出版日期2014-2