Clinical Characteristics, Prognosis and Treatment of Bloodstream Infections with Enterobacter Cloacae Complex in a Chinese Tertiary Hospital: A Retrospective Study

Yanhua Liu; Fuxing Li; Youling Fang; Qiaoshi Zhong; Yanping Xiao; Yunwei Zheng; Junqi Zhu; Chuwen Zhao; Xingwei Cao; Jianqiu Xiong; Longhua Hu

doi:10.2147/IDR.S460744

Clinical Characteristics, Prognosis and Treatment of Bloodstream Infections with Enterobacter Cloacae Complex in a Chinese Tertiary Hospital: A Retrospective Study

Infect Drug Resist. 2024 May 9:17:1811-1825. doi: 10.2147/IDR.S460744. eCollection 2024.

Authors

Yanhua Liu^#^{1

2}, Fuxing Li^#^{1

2}, Youling Fang^{2

3}, Qiaoshi Zhong^{1

2}, Yanping Xiao^{1

2}, Yunwei Zheng^{1

2}, Junqi Zhu^{2

3}, Chuwen Zhao^{2

3}, Xingwei Cao^{1

2}, Jianqiu Xiong⁴, Longhua Hu^{1

2}

Affiliations

¹ The Second Affiliated Hospital, Jiangxi Medical College, Nanchang University, Jiangxi, Nanchang, People's Republic of China.
² Department of Jiangxi Provincial Key Laboratory of Medicine, Clinical Laboratory of the Second Affiliated Hospital of Nanchang University, Jiangxi, Nanchang, People's Republic of China.
³ School of Public Health, Nanchang University, Jiangxi, Nanchang, People's Republic of China.
⁴ Department of Nursing, the Second Affiliated Hospital of Nanchang University, Jiangxi, Nanchang, People's Republic of China.

^# Contributed equally.

Abstract

Objective: This research aimed to analyze the clinical characteristics, prognosis, and antimicrobial treatment of bloodstream infections (BSI) caused by Enterobacter cloacae complex (ECC).

Methods: The clinical data of patients with bloodstream infections caused by Enterobacter cloacae complex from April 2017 to June 2023 were collected retrospectively. These data were then analyzed in subgroups based on the detection results of extended-spectrum β-lactamase (ESBL), 30-day mortality, and the type of antimicrobial agent used (β-lactam/β-lactamase inhibitor combinations (BLICs) or carbapenems).

Results: The proportion of ESBL-producing Enterobacter cloacae complex was 32.5% (37/114). Meanwhile, ICU admission, receiving surgical treatment within 3 months, and biliary tract infection were identified as risk factors for ESBL-producing ECC-BSI. Additionally, immunocompromised status and Sequential Organ Failure Assessment (SOFA) score ≥ 6.0 were identified as independent risk factors of 30-day mortality in patients with ECC-BSI (n = 108). Further analysis in BSI patients caused by non-ESBL-producing ECC revealed that patients treated with BLICs (n = 45) had lower SOFA scores and lower incidence of hypoproteinemia and sepsis compared with patients treated with carbapenems (n = 20). Moreover, in non-ESBL-producing ECC-BSI patients, the univariate Cox regression analysis indicated a significantly lower 30-day mortality rate in patients treated with BLICs compared to those treated with carbapenems (hazard ratios (HR) [95% CI] 0.190 [0.055-0.662], P = 0.009; adjusted HR [95% CI] 0.106 [0.013-0.863], P = 0.036).

Conclusion: This study investigated the factors influencing the susceptibility to infection by ESBL-producing strains and risk factors for 30-day mortality in ECC-BSI patients. The results revealed that ESBL-negative ECC-BSI patients treated with BLICs exhibited significantly lower 30-day mortality compared to those treated with carbapenems. BLICs were found to be more effective in ECC-BSI patients with milder disease (ESBL-negative and SOFA ≤6.0).

Keywords: Enterobacter cloacae complex; bloodstream infection; carbapenems; extended-spectrum β-lactamase; risk factors; β-lactam/β- lactamase inhibitor combinations.

Grants and funding

This study was supported by the National Natural Science Foundation of China (82060391), the Chinese Medical Science and Technology Research Projects of Jiangxi Provincial Administration of Traditional Chinese Medicine (2023Z030), the Medical Health Science and Technology Project of Jiangxi Provincial Health Commission (202130412), the Postgraduate Innovation Special Foundation of Jiangxi Province (YC2023-B093), and the Foundation of Jiangxi Health Commission (202210568).