Colonisation and infection due to Enterobacteriaceae producing plasmid-mediated AmpC ß-lactamases.
J Infect
; 64(2): 176-83, 2012 Feb.
Article
em En
| MEDLINE
| ID: mdl-22138600
OBJECTIVES: To investigate the epidemiology and clinical features of infections caused by Enterobacteria producing plasmid-mediated AmpC ß-lactamases (pAmpC), which are emerging as a cause of resistance to extended-spectrum cephalosporins. METHODS: A prospective multicentre cohort of patients with infection/colonisation due to pAmpC-producing Enterobacteriaceae was performed in 7 Spanish hospitals from February throughout July 2009. pAmpCs were characterised by PCR and sequencing. RESULTS: 140 patients were included; organisms isolated were Escherichia coli (n = 100), Proteus mirabilis (n = 20), Klebsiella pneumoniae (n = 17), and others (n = 3). Overall, 90% had a chronic underlying condition. The acquisition was nosocomial in 43%, healthcare-associated in 41% (14% of those were nursing home residents), and community in 16%. Only 5% of patients had no predisposing feature for infection with multidrug-resistant bacteria. Nineteen percent of patients were bacteraemic. Inappropriate empirical therapy was administered to 81% of bacteraemic patients, who had a crude mortality rate of 48%. The most frequent enzyme was CMY-2 (70%, predominantly in E. coli and P. mirabilis) followed by DHA-1 (19%, predominantly in K. pneumoniae). CONCLUSION: pAmpC-producing Enterobacteriaceae caused nosocomial, healthcare-associated and community infections mainly in predisposed patients. Invasive infections were associated with high mortality which might be partly related to inappropriate empirical therapy.
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Base de dados:
MEDLINE
Assunto principal:
Proteínas de Bactérias
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Beta-Lactamases
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Farmacorresistência Bacteriana Múltipla
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Enterobacteriaceae
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Infecções por Enterobacteriaceae
Idioma:
En
Ano de publicação:
2012
Tipo de documento:
Article