Enterobacter cloacae infection characteristics and outcomes in battlefield trauma patients.
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...
| Main Authors: | , , , , , , , , |
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| Format: | Article |
| Language: | English |
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Public Library of Science (PLoS)
2023-01-01
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| Series: | PLoS ONE |
| Online Access: | https://doi.org/10.1371/journal.pone.0290735 |
| _version_ | 1797690832480894976 |
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| author | William Bennett Katrin Mende Wesley R Campbell Miriam Beckius Laveta Stewart Faraz Shaikh Azizur Rahman David R Tribble Joseph M Yabes |
| author_facet | William Bennett Katrin Mende Wesley R Campbell Miriam Beckius Laveta Stewart Faraz Shaikh Azizur Rahman David R Tribble Joseph M Yabes |
| author_sort | William Bennett |
| collection | DOAJ |
| description | 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. |
| first_indexed | 2024-03-12T02:04:48Z |
| format | Article |
| id | doaj.art-0c0c9bd99d56474992a1f65c0cb8ac5d |
| institution | Directory Open Access Journal |
| issn | 1932-6203 |
| language | English |
| last_indexed | 2024-03-12T02:04:48Z |
| publishDate | 2023-01-01 |
| publisher | Public Library of Science (PLoS) |
| record_format | Article |
| series | PLoS ONE |
| spelling | doaj.art-0c0c9bd99d56474992a1f65c0cb8ac5d2023-09-07T05:31:16ZengPublic Library of Science (PLoS)PLoS ONE1932-62032023-01-01188e029073510.1371/journal.pone.0290735Enterobacter cloacae infection characteristics and outcomes in battlefield trauma patients.William BennettKatrin MendeWesley R CampbellMiriam BeckiusLaveta StewartFaraz ShaikhAzizur RahmanDavid R TribbleJoseph M YabesEnterobacter 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.https://doi.org/10.1371/journal.pone.0290735 |
| spellingShingle | William Bennett Katrin Mende Wesley R Campbell Miriam Beckius Laveta Stewart Faraz Shaikh Azizur Rahman David R Tribble Joseph M Yabes Enterobacter cloacae infection characteristics and outcomes in battlefield trauma patients. PLoS ONE |
| title | Enterobacter cloacae infection characteristics and outcomes in battlefield trauma patients. |
| title_full | Enterobacter cloacae infection characteristics and outcomes in battlefield trauma patients. |
| title_fullStr | Enterobacter cloacae infection characteristics and outcomes in battlefield trauma patients. |
| title_full_unstemmed | Enterobacter cloacae infection characteristics and outcomes in battlefield trauma patients. |
| title_short | Enterobacter cloacae infection characteristics and outcomes in battlefield trauma patients. |
| title_sort | enterobacter cloacae infection characteristics and outcomes in battlefield trauma patients |
| url | https://doi.org/10.1371/journal.pone.0290735 |
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