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Table 2 Clinical characteristics and outcomes of infections caused by carbapenemase-producing Enterobacterales strains

From: Institutional outbreak involving multiple clades of IMP-producing Enterobacter cloacae complex sequence type 78 at a cancer center in Tokyo, Japan

Patient No. Diagnosis of the infectious diseases Setting Samples positive for CPE Adequate source control Antimicrobial treatmenta Prognosis Comment
1 Cholangitis Liver abscess After resection of gastrointestinal malignancy and choledochoduodenostomy Blood (Day 1, Day 28)
Drained abscess (Day 29)
Established (percutaneous abscess drainage) (Day 1–3) FEP (IV)
(Day 3–8) MEM (IV) + GEN (IV)
(Day 9–28) MEM (IV)
(Day 29–30) MEM + GEN (IV) + LVX (IV)
(Day 31–43) MEM (HD-EX, IV) +
GEN (IV) + LVX (IV)
(Day 44–74) TZP (HD-EX, IV) +
GEN (IV) + LVX (IV)
Cure without 2nd relapse Cholangitis with bacteremia due to CPE developed 9 days after surgery was treated with MEM (Day 3–28) according to the susceptible result at the hospital. Although fever and bacteremia were once resolved, they recurred on Day 28. CT scan of the abdomen revealed liver abscess. Percutaneous abscess drainage was performed and antimicrobial treatment was re-initiated. TZP (Day 44–74) was selected according to the susceptible result at the hospital.
3 Surgical site infection (deep incisional) After resection of gastrointestinal malignancy Abscess (Day 1) Established (incision and drainage) (Day 1–9) TZP (IV)
(Day 9–17) MEM (IV)
(Day 17–25) LVX (PO)
Cure without relapse Deep incisional surgical site infection developed 5 days after surgery. MEM (Day 9–17) was selected according to the susceptible result at the hospital.
4 Intraabdominal infection Under palliative care for advanced gastrointestinal malignancy Intraabdominal fluid (Day 1) Unestablished (Day 1–6) MEM (IV)
(Day 6–11) IPM (IV)
Death (Day 11) Although intestinal perforation was suspected by imaging studies, surgical intervention was not performed because the patient was on do-not-resuscitate order due to his advanced cancer. IPM (Day 6–11) was selected according to the susceptible result at the hospital.
8 Intraabdominal infection After resection of gastrointestinal malignancy Intraabdominal fluid (Day 1) Established (percutaneous fluid drainage) (Day 1–7) AMC (PO) Cure without relapse An intraabdominal fluid collection was found on abdominal CT scan 34 days after surgery. Percutaneous fluid drainage was performed and the culture of fluid grew CPE. A low-grade fever subsided after the percutaneous fluid drainage.
15 Pneumonia After resection of gastrointestinal malignancy Sputum (Day 1) Unnecessary (Day 1–3) SAM (IV)
(Day 3–14) MEM (IV) + LVX (IV)
Cure without relapse High fever and productive cough developed on the next day of surgery, A new pulmonary infiltrate was found on chest X-ray.
16 Surgical site infection (deep incisional and intraabdominal space) After resection of gastrointestinal malignancy Blood (Day 1)
Abscess (Day 1)
Intraabdominal fluid (Day 3)
Established (incision and drainage of the wound surface, and percutaneous peritoneal drainage) (Day 1–3) MEM (IV) + GM (IV)
(Day 3–21) MEM (HD-EX, IV) + GEN (IV)
(Day 22–24) SXT (PO)
(Day 24–38) LVX (PO)
Cure without relapse CPE was first identified from surveillance bile culture during the surgery prior to the onset of infection. SXT was changed to LVX (Day 24) due to the possible side effect of nausea.
  1. a Only antimicrobial agents with activity gram-negative organisms were presented. Antimicrobial agents against which the causative organisms were susceptible by antimicrobial susceptibility testing with BD Phoenix NMIC/ID-208 panel interpreted with CLSI M100-S27 guidelines were underlined
  2. FEP cefepime, MEM meropenem, GEN gentamicin, LVX levofloxacin, TZP piperacillin-tazobactam, IPM imipenem, AMC amoxicillin-clavulanic acid, SAM ampicillin-sulbactam, SXT trimethoprim-sulfamethoxazole, HD-EX high-dose and extended infusion, IV intravenous, PO oral
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