In:
PLOS ONE, Public Library of Science (PLoS), Vol. 18, No. 8 ( 2023-8-29), p. e0290735-
Abstract:
Enterobacter cloacae is a Gram-negative rod with multidrug-resistant potential due to chromosomally-induced AmpC β-lactamase. We evaluated characteristics, antibiotic utilization, and outcomes associated with battlefield-related E . cloacae infections (2009–2014). Single initial and serial E . cloacae isolates (≥24 hours from initial isolate from any site) associated with a clinical infection were examined. Susceptibility profiles of initial isolates in the serial isolation group were contrasted against last isolate recovered. Characteristics of 112 patients with E . cloacae infections (63 [56%] with single initial isolation; 49 [44%] with serial isolation) were compared to 509 patients with bacterial infections not attributed to E . cloacae . E . cloacae patients sustained more blast trauma (78%) compared to non- E . cloacae infections patients (75%; p 〈 0.001); however, injury severity scores were comparable (median of 34.5 and 33, respectively; p = 0.334). Patients with E . cloacae infections had greater shock indices (median 1.07 vs 0.92; p = 0.005) and required more initial blood products (15 vs. 14 units; p = 0.032) compared to patients with non- E . cloacae infections. Although E . cloacae patients had less intensive care unit admissions (80% vs. 90% with non- E . cloacae infection patients; p = 0.007), they did have more operating room visits (5 vs. 4; p = 0.001), longer duration of antibiotic therapy (43.5 vs. 34 days; p 〈 0.001), and lengthier hospitalizations (57 vs. 44 days; p 〈 0.001). Patients with serial E . cloacae had isolation of infecting isolates sooner than patients with single initial E . cloacae (median of 5 vs. 8 days post-injury; p = 0.046); however, outcomes were not significantly different between the groups. Statistically significant resistance to individual antibiotics did not develop between initial and last isolates in the serial isolation group. Despite current combat care and surgical prophylaxis guidelines recommending upfront provision of AmpC-inducing antibiotics, clinical outcomes did not differ nor did significant antibiotic resistance develop in patients who experienced serial isolation of E . cloacae versus single initial isolation.
Type of Medium:
Online Resource
ISSN:
1932-6203
DOI:
10.1371/journal.pone.0290735
DOI:
10.1371/journal.pone.0290735.g001
DOI:
10.1371/journal.pone.0290735.t001
DOI:
10.1371/journal.pone.0290735.t002
DOI:
10.1371/journal.pone.0290735.t003
DOI:
10.1371/journal.pone.0290735.t004
DOI:
10.1371/journal.pone.0290735.t005
DOI:
10.1371/journal.pone.0290735.s001
DOI:
10.1371/journal.pone.0290735.s002
DOI:
10.1371/journal.pone.0290735.r001
DOI:
10.1371/journal.pone.0290735.r002
DOI:
10.1371/journal.pone.0290735.r003
DOI:
10.1371/journal.pone.0290735.r004
DOI:
10.1371/journal.pone.0290735.r005
DOI:
10.1371/journal.pone.0290735.r006
Language:
English
Publisher:
Public Library of Science (PLoS)
Publication Date:
2023
detail.hit.zdb_id:
2267670-3
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