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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
The conclusions, findings, and opinions expressed by authors contributing to this journal do not necessarily reflect the official position of the U.S. Department of Health and Human Services, the Public Health Service, the Centers for Disease Control and Prevention, or the authors' affiliated institutions. Use of trade names is for identification only and does not imply endorsement by any of the groups named above.
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