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Clinical Failure and Emergence of Resistance during Third Generation Cephalosporin Therapy for Enterobacter spp. Infection: Is the Risk Overestimated? A Prospective Multicentric Study

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Equipe Mobile de Microbiologie Clinique, Groupe Hospitalier Paris Saint-Joseph, 75014 Paris, France
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EA4043 Unité Bactéries Pathogènes et Santé, Université Paris-Sud Saclay, 92290 Chatenay-Malabry, France
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Laboratoire de Microbiologie, Unité de Prévention et de Lutte Contre les Infections Nosocomiales, GH Paris Seine Saint-Denis, APHP, 93022 Bobigny, France
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INSERM, IAME, UMR 1137, Université de Paris, 75018 Paris, France
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Service de Maladies Infectieuses et Tropicales, 94190 Villeneuve Saint Georges, France
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Assistance Publique Hôpitaux de Paris, Hôpitaux Universitaires Paris Centre-Site Cochin, Antimicrobial Stewardship Team, 75014 Paris, France
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Faculté de Médecine, Sorbonne Paris Cité, Université de Paris, 75006 Paris, France
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Service de Microbiologie Clinique, Groupe Hospitalier Paris Saint-Joseph, 75014 Paris, France
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Service des Maladies Infectieuses et Tropicales, Pitié Salpêtrière—Charles Foix, 75013 Paris, France
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Unité Fonctionnelle Infectiologie, Hôpital St. Louis, 75010 Paris, France
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Laboratoire de Microbiologie, GH Paris Seine Saint-Denis, APHP, 93022 Bobigny, France
*
Author to whom correspondence should be addressed.
Received: 27 April 2021 / Revised: 23 June 2021 / Accepted: 24 June 2021 / Published: 20 August 2021
(This article belongs to the Section Infectious Disease Epidemiology, Prevention and Control)
Background: Clinical and microbiological guidelines recommend treating infections caused by Enterobacter spp. with cefepime or carbapenems. The main objective of this study was to assess the risk of clinical failure with third generation cephalosporin (3GC) therapy compared to other β-lactams for infections caused by Enterobacter spp. Our secondary objective was to evaluate the risk of emergence of resistance during therapy. Methods: We conducted a prospective observational study in seven French hospitals over an 18-month period including all patients with a pulmonary and/or bloodstream infection due to Enterobacter spp. susceptible to 3GC. Results: Seventy-four patients were included in our study. Among them, 26 (35%) received a 3GC as a first-line treatment, and clinical improvements were observed for 13/21 (62%) of them. Four (5%) cases of emergence of 3GC resistance were observed during therapy including one in the 3GC group. 3GC therapy can be safely used as first-line therapy especially for non-severe patients suffering from pulmonary or bloodstream infections due to Enterobacter spp. Conclusions: Emergence of 3GC resistance remains a rare event, and there is a lack of evidence of the benefit of last-line antibiotics therapies. View Full-Text
Keywords: AmpC producing Enterobacteriaceae; cefepime; piperacilline/tazobactam; third generation cephalosporin AmpC producing Enterobacteriaceae; cefepime; piperacilline/tazobactam; third generation cephalosporin
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MDPI and ACS Style

Pilmis, B.; Delerue, T.; Belkacem, A.; Caraux-Paz, P.; Kernéis, S.; Alviset, S.; Canoui, E.; Mizrahi, A.; Bleibtreu, A.; Lafaurie, M.; Carbonnelle, E.; Zahar, J.-R. Clinical Failure and Emergence of Resistance during Third Generation Cephalosporin Therapy for Enterobacter spp. Infection: Is the Risk Overestimated? A Prospective Multicentric Study. Hygiene 2021, 1, 69-79. https://0-doi-org.brum.beds.ac.uk/10.3390/hygiene1020007

AMA Style

Pilmis B, Delerue T, Belkacem A, Caraux-Paz P, Kernéis S, Alviset S, Canoui E, Mizrahi A, Bleibtreu A, Lafaurie M, Carbonnelle E, Zahar J-R. Clinical Failure and Emergence of Resistance during Third Generation Cephalosporin Therapy for Enterobacter spp. Infection: Is the Risk Overestimated? A Prospective Multicentric Study. Hygiene. 2021; 1(2):69-79. https://0-doi-org.brum.beds.ac.uk/10.3390/hygiene1020007

Chicago/Turabian Style

Pilmis, Benoît, Thibaud Delerue, Anna Belkacem, Pauline Caraux-Paz, Solen Kernéis, Sophie Alviset, Etienne Canoui, Assaf Mizrahi, Alexandre Bleibtreu, Matthieu Lafaurie, Etienne Carbonnelle, and Jean-Ralph Zahar. 2021. "Clinical Failure and Emergence of Resistance during Third Generation Cephalosporin Therapy for Enterobacter spp. Infection: Is the Risk Overestimated? A Prospective Multicentric Study" Hygiene 1, no. 2: 69-79. https://0-doi-org.brum.beds.ac.uk/10.3390/hygiene1020007

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