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Volume 24, Number 8—August 2018
Research

Novel Enterobacter Lineage as Leading Cause of Nosocomial Outbreak Involving Carbapenemase-Producing Strains

Racha Beyrouthy, Marion Barets, Elodie Marion, Cédric Dananché, Olivier Dauwalder, Frédéric Robin, Lauraine Gauthier, Agnès Jousset, Laurent Dortet, François Guérin, Thomas Bénet, Pierre Cassier, Philippe Vanhems1, and Richard Bonnet1Comments to Author 
Author affiliations: Centre Hospitalier Universitaire, Clermont-Ferrand, France (R. Beyrouthy, F. Robin, R. Bonnet); Centre National de Référence de la Résistance aux Antibiotiques, Clermont-Ferrand (R. Beyrouthy, F. Robin, R. Bonnet); Université Clermont Auvergne, Clermont-Ferrand (R. Beyrouthy, F. Robin, R. Bonnet); Institut National de la Santé et de la Recherche Médicale, Clermont-Ferrand (R. Beyrouthy, F. Robin, R. Bonnet); Institut National de la Recherche Agronomique, Clermont-Ferrand (R. Beyrouthy, F. Robin, R. Bonnet); Hôpital Édouard Herriot, Hospices Civils de Lyon, Lyon, France (M. Barets, E. Marion, C. Dananché, T. Bénet, P. Cassier, P. Vanhems); Groupement Hospitalier Est, Hospices Civils de Lyon, Lyon (O. Dauwalder); Centre International de Recherche en Infectiologie, Lyon (O. Dauwalder, T. Bénet, P. Vanhems),; Centre Hospitalier Universitaire Bicêtre, Paris, France (L. Gauthier, A. Jousset, L. Dortet); Centre National de Référence Associé de la Résistance aux Antibiotiques, Paris (L. Gauthier, A. Jousset, L. Dortet); Centre Hospitalier Universitaire, Caen, France (F. Guérin)

Main Article

Table 1

Case descriptions of VIM-4–producing Enterobacter cloacae complex nosocomial infections in outbreak involving carbapenemase-producing strains, Lyon, France, January 12, 2014–December 31, 2015*

Characteristic Patient no.
P1 P2 P3 P4 P5 P6 P7
Patient age, y/sex
67/F
72/M
64/F
69/M
87/M
84/F
82/M
Hospitalization duration 10 d 106 d 52 d 26 d 6 d 69 d 36 d
Purpose of hospitalization Kidney transplant Peripheral arterial disease Septic shock Kidney transplant Consciousness disorder Necrotic purpura Vesical lithotrity
Type of ward
Transplant, medicine
Surgery, medical, ICU
Medical, ICU
Transplant, medical
Medical, ICU
Medical
Surgery, medical, ICU
Antimicrobial therapy before diagnosis†
VAN, OFL, AMX
PTZ, VAN, AMI, MEM,† CTR
CTR, VAN, TZP, MET, AMI, CLI, IMP†
AMX, VAN
AMC
CTR, GEN
CTX, OFL, AMX, PTZ, GEN
Urinary catheter Yes Yes Yes Yes Yes No Yes
Intubation No Yes Yes No No No No
Central venous catheter
Yes
Yes
Yes
Yes
No
No
No
In-hospital death: delay from admission, d, and etiology
No
Yes: 106, septic shock from respiratory system
Yes: 52, septic shock, undetermined origin
No
No
No
Yes: 36, septic shock, peritonitis with hemorrhage
Last negative sample;‡ delay from admission, d
Urinary; 7
Urinary; 61
Urinary; 1
Urinary; 20
Rectal swab; 2
Necrotic skin; 39
Urinary; 2
First positive sample Urinary Urinary Urinary Urinary Urinary Necrotic Skin Peritoneal fluid
Delay from admission, d 32 76 41 29 20 49 28
Delay from last negative sample, d
25
15
40
9
18
10
26
ST ST873 ST873 ST118 ST873 ST118 ST873 ST110
Isolate identification C45 C46 C47 C48 C308 C310 C309

*AMI, amikacin; AMX, amoxicillin; AMC, amoxicillin-clavulanate; CLI, clindamycin; CTR, ceftriaxone; CTX, cefotaxime; GEN, gentamicin; ICU, intensive care unit; ICU, intensive care unit; IMP, imipenem; MET, metronidazole; MEM, meropenem; OFL, ofloxacin; PTZ, piperacillin/tazobactam; ST, sequence type; VAN, vancomycin.
†Carbapenems.
‡For detection of VIM-4–producing Enterobacter cloacae complex.

Main Article

1These authors contributed equally to this article.

Page created: July 18, 2018
Page updated: July 18, 2018
Page reviewed: July 18, 2018
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