Brooke Army Medical Center, JBSA Fort Sam Houston, Texas, United States of America.
Uniformed Services University of the Health Sciences, Bethesda, MD, United States of America.
PLoS One. 2023 Aug 29;18(8):e0290735. doi: 10.1371/journal.pone.0290735. eCollection 2023.
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.
阴沟肠杆菌是一种革兰氏阴性杆菌，由于染色体诱导的 AmpC β-内酰胺酶而具有多药耐药潜力。我们评估了与战场相关的阴沟肠杆菌感染（2009-2014 年）的特征、抗生素使用情况和结果。检查了与临床感染相关的单个初始和连续阴沟肠杆菌分离株（任何部位初始分离株后≥24 小时）。比较了连续分离组中初始分离株的药敏谱与最后分离株的药敏谱。将 112 例阴沟肠杆菌感染患者（63 例为单一初始分离；49 例为连续分离）的特征与 509 例非阴沟肠杆菌感染患者的特征进行了比较。与非阴沟肠杆菌感染患者相比，阴沟肠杆菌感染患者的爆炸伤更多（78%比 75%；p<0.001）；然而，损伤严重程度评分相似（中位数分别为 34.5 和 33；p = 0.334）。与非阴沟肠杆菌感染患者相比，阴沟肠杆菌感染患者的休克指数更高（中位数为 1.07 比 0.92；p = 0.005），需要更多的初始血制品（15 单位比 14 单位；p = 0.032）。尽管阴沟肠杆菌感染患者 ICU 入院率较低（80%比非阴沟肠杆菌感染患者的 90%；p = 0.007），但他们的手术室就诊次数更多（5 次比 4 次；p = 0.001），抗生素治疗时间更长（43.5 天比 34 天；p<0.001），住院时间更长（57 天比 44 天；p<0.001）。与单一初始阴沟肠杆菌感染患者相比，连续阴沟肠杆菌感染患者更早分离出感染分离株（损伤后 5 天与 8 天；p = 0.046）；然而，两组之间的结果并无显著差异。在连续分离组中，初始和最后分离株之间并没有出现针对个别抗生素的显著耐药性。尽管目前的战斗护理和手术预防指南建议提前提供 AmpC 诱导抗生素，但经历阴沟肠杆菌连续分离的患者与单一初始分离的患者相比，临床结局并无差异，也没有出现显著的抗生素耐药性。
