ArticleInternational journal of antimicrobial agents2013
Characterisation and clinical features of Enterobacter cloacae bloodstream infections occurring at a tertiary care university hospital in Switzerland: is cefepime adequate therapy?
Article in International journal of antimicrobial agents, 2013. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 28 papers, 1 of them a synthesis that pooled it.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
28 citing papers in PubMed, 1 synthesis or guideline pooled it, 63 citations in OpenAlex.
- Pooled it
- Impact of third-generation cephalosporin and carbapenem resistance profiles on the mortality of patients withJAC-antimicrobial resistance · 2026Article
- Cefepime Versus Carbapenem Therapy for the Treatment of Invasive Infections With Inducible Chromosomal AmpC-Producing Enterobacterales: A Systematic Review and Meta-analysis.Open forum infectious diseases · 2025Article
- Cefepime versus carbapenem for treating complicated urinary tract infection caused by cefoxitin-nonsusceptible ESCPM organisms: a multicenter, real-world study.BMC infectious diseases · 2025Article
- Antibiotic Treatment of Infections Caused by AmpC-Producing Enterobacterales.Pharmacy (Basel, Switzerland) · 2024Review
- When does antimicrobial resistance increase bacterial fitness? Effects of dosing, social interactions, and frequency dependence on the benefits of AmpCEvolution letters · 2024Article
- Antimicrobial Resistance in Papua New Guinea: A Narrative Scoping Review.Antibiotics (Basel, Switzerland) · 2023Article
- Class C β-Lactamases: Molecular Characteristics.Clinical microbiology reviews · 2022Review
- A comprehensive description of the TolC effect on the antimicrobial susceptibility profile inFrontiers in cellular and infection microbiology · 2022Article
- Emergence of Resistance inAntimicrobial agents and chemotherapy · 2021Article
- Non-thermal Plasma Treatment of ESKAPE Pathogens: A Review.Frontiers in microbiology · 2021Review
- An Evidence-Based Multidisciplinary Approach Focused at Creating Algorithms for Targeted Therapy of BSIs, cUTIs, and cIAIs Caused byInfection and drug resistance · 2021Article
- Gram-Negative Bloodstream Infection: Implications of Antimicrobial Resistance on Clinical Outcomes and Therapy.Antibiotics (Basel, Switzerland) · 2020Article
- [Epidemiological analysis of pathogens causing bloodstream infections in department of hematology in Guangdong Province].Zhonghua xue ye xue za zhi = Zhonghua xueyexue zazhi · 2020Article
- Strong Environment-Genotype Interactions Determine the Fitness Costs of Antibiotic ResistanceAntimicrobial agents and chemotherapy · 2020Article
- Multicenter, Observational Cohort Study Evaluating Third-Generation Cephalosporin Therapy for Bloodstream Infections Secondary toAntibiotics (Basel, Switzerland) · 2020Article
- A Primer on AmpC β-Lactamases: Necessary Knowledge for an Increasingly Multidrug-resistant World.Clinical infectious diseases : an official publication of the Infectious Diseases Society of America · 2019Review
- Review
- GradualFrontiers in microbiology · 2019Article
- Article
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
9 authors at 3 institutions in 2 countries.
Funding
Abstract
Despite many years of clinical experience with cefepime, data regarding the outcome of patients suffering from bloodstream infections (BSIs) due to Enterobacter cloacae (Ecl) are scarce. To address the gap in our knowledge, 57 Ecl responsible for 51 BSIs were analysed implementing phenotypic and molecular methods (microarrays, PCRs for bla and other genes, rep-PCR to analyse clonality). Only two E. cloacae (3.5%) were ESBL-producers, whereas 34 (59.6%) and 18 (31.6%) possessed inducible (Ind-Ecl) or derepressed (Der-Ecl) AmpC enzymes, respectively. All isolates were susceptible to imipenem, meropenem, gentamicin and ciprofloxacin. Der-Ecl were highly resistant to ceftazidime and piperacillin/tazobactam (both MIC₉₀≥256 μg/mL), whereas cefepime retained its activity (MIC₉₀ of 3 μg/mL). rep-PCR indicated that the isolates were sporadic, but Ecl collected from the same patients were indistinguishable. In particular, three BSIs initially due to Ind-Ecl evolved (under ceftriaxone or piperacillin/tazobactam treatment) into Der-Ecl because of mutations or a deletion in ampD or insertion of IS4321 in the promoter. These last two mechanisms have never been described in Ecl. Mortality was higher for BSIs due to Der-Ecl than Ind-Ecl (3.8% vs. 29.4%; P=0.028) and was associated with the Charlson co-morbidity index (P=0.046). Using the following directed treatments, patients with BSI showed a favourable treatment outcome: cefepime (16/18; 88.9%); carbapenems (12/13; 92.3%); ceftriaxone (4/7; 57.1%); piperacillin/tazobactam (5/7; 71.4%); and ciprofloxacin (6/6; 100%). Cefepime represents a safe therapeutic option and an alternative to carbapenems to treat BSIs due to Ecl when the prevalence of ESBL-producers is low.
Indexed as
Identifiers
What OpenQuestion holds
Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.