Article Figures & Data
Tables
- TABLE 1.
MICs and molecular results for all P. mirabilis isolates causing BSI during the study period (January 1997 to June 2004)
Isolate MIC of antimicrobial agent (μg/ml)a Type of enzymes produced AMP SAM AMC FOX PIP TZP CRO CTX CTL CAZ TZL FEP IPM MEM ATM CIP LVX AMK GEN TOB 43/97 >256 2 4 3 >256 0.75 3 8 0.032 2 0.064 4 1.5 0.125 0.125 4 4 4 96 16 TEM-52, TEM-1 1/98 >256 4 6 3 >256 0.5 4 8 0.032 2 0.064 4 3 0.064 0.094 >32 8 3 >256 6 TEM-52 405/01 >256 8 6 4 >256 0.5 3 8 0.032 4 0.250 3 0.5 0.094 0.38 >32 >32 4 >256 24 TEM-92 130/02 >256 2 6 2 >256 0.38 8 32 0.094 1 0.032 3 2 0.047 0.064 >32 16 3 >256 8 TEM-92, TEM-1 629/02 >256 8 12 4 >256 0.75 4 4 0.032 2 0.064 8 1 0.094 0.094 >32 >32 4 >256 24 TEM-92 139/03b >256 4 8 4 >256 0.5 4 8 0.032 2 0.064 32 1 0.064 0.125 >32 >32 4 >256 24 TEM-92 309/03b >256 4 8 4 >256 0.5 4 8 0.032 2 0.064 32 1 0.064 0.125 >32 >32 4 >256 24 TEM-92 463/03b >256 4 8 4 >256 0.5 4 8 0.032 2 0.064 32 1 0.064 0.125 >32 >32 4 >256 24 TEM-92 601/03 >256 2 4 4 >256 1 2 8 0.032 2 0.064 3 2 0.094 0.19 >32 >32 1.5 64 4 TEM-92, TEM-1 A19/03 >256 8 2 1.5 >256 0.75 2 4 0.032 2 0.064 2 2 0.047 0.047 0.75 2 3 96 8 TEM-92 A68/03 >256 4 4 6 >256 1 1.5 6 0.094 4 0.125 4 0.25 0.032 0.125 16 >32 1 64 4 TEM-92 65/99 >256 4 0.5 1 0.125 0.125 <0.016 <0.016 <0.016 <0.016 <0.016 0.064 0.5 0.023 <0.016 0.016 0.032 1.5 0.5 0.75 TEM-1 1289/01 >256 4 3 1.5 0.5 0.19 <0.016 <0.016 <0.016 <0.016 <0.016 0.047 0.75 0.032 <0.016 1 4 1.5 12 2 TEM-1 2501/01 0.5 0.5 0.38 2 0.125 0.125 <0.016 <0.016 <0.016 <0.016 <0.016 <0.016 1 0.032 <0.016 0.016 0.032 1 0.5 0.75 None 2512/01 0.5 0.5 0.38 1 0.125 0.125 <0.016 <0.016 <0.016 <0.016 <0.016 <0.016 0.5 0.032 <0.016 0.016 0.032 1 0.5 0.75 None 108/02 >256 8 1.5 1.5 0.5 0.19 <0.016 <0.016 <0.016 <0.016 <0.016 0.032 1 0.023 <0.016 0.016 0.032 2 1 0.5 TEM-1 461/02 0.5 0.5 0.38 1 0.125 0.125 <0.016 <0.016 <0.016 <0.016 <0.016 <0.016 0.75 0.032 <0.016 0.032 0.047 1.5 0.5 0.5 None 683/02 0.75 0.5 0.38 1 0.125 0.125 <0.016 <0.016 <0.016 <0.016 <0.016 0.094 1 0.032 <0.016 0.016 0.032 2 0.5 0.75 None 794/02 >256 2 0.5 1 0.125 0.125 <0.016 <0.016 <0.016 <0.016 <0.016 0.064 0.5 0.023 <0.016 0.016 0.032 6 128 32 TEM-1 85/03 1 1 0.38 1 0.125 0.125 <0.016 <0.016 <0.016 <0.016 <0.016 0.032 1 0.032 <0.016 0.016 0.032 1.5 4 8 None 654/03 >256 2 0.5 2 0.38 0.19 <0.016 <0.016 <0.016 <0.016 <0.016 0.032 0.75 0.032 <0.016 0.016 0.032 0.5 1 0.5 TEM-1 753/03 0.5 0.5 0.38 1 0.125 0.125 <0.016 <0.016 <0.016 <0.016 <0.016 <0.016 1 0.032 <0.016 0.016 0.032 2 0.5 0.75 None A48/03 1 0.75 0.38 1 0.75 0.75 <0.016 <0.016 <0.016 <0.016 <0.016 <0.016 0.5 0.016 <0.016 0.016 0.032 1.5 2 1 None 134/04 >256 4 0.38 1 0.125 0.094 <0.016 <0.016 <0.016 <0.016 <0.016 0.047 1 0.032 <0.016 0.032 0.064 2 128 4 TEM-1 634/04 1 1 0.38 1 0.25 0.125 <0.016 <0.016 <0.016 <0.016 <0.016 0.023 1 0.032 <0.016 2 4 0.5 2 0.75 None ↵ a Abbreviations for antimicrobial agents follow (NCCLS 2004 breakpoints for susceptibility [S] and resistance [R] [in micrograms per milliliter] are given in parentheses): AMP, ampicillin (S ≤ 8, R ≥ 32); SAM, ampicillin plus sulbactam (S ≤ 8/4, R ≥ 32/16); AMC, amoxicillin plus clavulanate (S ≤ 8/4, R ≥ 32/16); FOX, cefoxitin (S ≤ 8, R ≥ 32); PIP, piperacillin (S ≤ 16, R ≥ 128); TZP, piperacillin plus tazobactam (S ≤ 16/4, R ≥ 128/4); CRO, ceftriaxone (S ≤ 8, R ≥ 64); CTX, cefotaxime (S ≤ 8, R ≥ 64); CTL, cefotaxime plus clavulanate; CAZ, ceftazidime (S ≤ 8, R ≥ 32); TZL, ceftazidime plus clavulanate; FEP, cefepime (S ≤ 8, R ≥ 32); IPM, imipenem (S ≤ 4, R ≥ 16); MEM, meropenem (S ≤ 4, R ≥ 16); ATM, aztreonam (S ≤ 8, R ≥ 32); CIP, eiprofloxacin (S ≤ 1, R ≥ 4); LVX, levofloxacin (S ≤ 2, R ≥ 8); AMK, amikacin (S ≤ 16, R ≥ 32); GEN, gentamicin (S ≤ 4, R ≥ 8); TOB, tobramycin (S ≤ 4, R ≥ 8).
↵ b These strains caused three different BSI in the same patient.
- TABLE 2.
Demographic and clinical parameters of patients with BSI due to Proteus mirabilis strains and differences between ESBL-P-PM and ESBL-N-PM isolates
Demographic and clinical parameters No. (%) of patientsa P valueb ESBL-P-PM ESBL-N-PM No. of BSI patients 9c 14 ND No. of BSI episodes 11c 14 ND Age (yr) (mean ± SD) 70.9 ± 17.5 67.3 ± 18.2 NS Sex (male/female) 7/2 7/7 ND McCabe and Jackson groupsd Nonfatal 5 (55.6) 8 (57.1) NS Ultimately fatal 3 (33.3) 4 (28.6) NS Rapidly fatal 1 (11.1) 2 (14.3) NS Charlson weighted index (mean ± SD)e 4.0 ± 2.5 4.1 ± 2.6 NS Severity of septicemia Sepsis 6 (66.7) 11 (78.6) NS Severe sepsis 2 (22.2) 2 (14.3) NS Septic shock 1 (11.1) 1 (7.1) NS Previous hospitalizations (during the last 12 months) 6 (66.7) 8 (57.1) NS Previous hospitalization in nursing home 5 (55.6) 3 (21.4) 0.04 Hospital-acquired BSI 3 (33.3) 6 (42.9) NS Hospital stay before BSI diagnosis (days) (mean ± SD) 16.8 ± 30.3 6.0 ± 6.9 0.10 Length of hospital stay (days) (mean ± SD) 86.2 ± 193.4 19.4 ± 8.0 0.10 Empirical treatment Provided 9 (100.0) 12 (85.7) NS Adequate 5 (55.6) 12 (85.7) 0.04 Adequate treatment after ID/AST results 4 (44.4) 12 (85.7) 0.04 Predisposing factors Bladder catheter 9 (100.0) 8 (57.1) 0.01 Previous use of antibiotics 4 (44.4) 3 (21.4) 0.09 Intravascular catheter 4 (44.4) 3 (21.4) 0.09 Corticosteroids or antineoplastic therapy 2 (22.2) 4 (28.6) NS Previous surgery 0 (0.0) 3 (21.4) NS Drainages 0 (0.0) 3 (21.4) NS Intubation 1 (11.1) 1 (7.1) NS Secondary BSI All patients 4 (44.4) 3 (21.4) 0.09 Urinary tract 4 (44.4)f 3 (21.4)g 0.09 Other 0 (0.0) 0 (0.0) NS Overall mortality 3 (33.3) 2 (14.3) NS Mortality attributable to BSI 3 (33.3) 0 (0.0) 0.04 ↵ a Data are number (%) of patients, unless otherwise indicated.
↵ b NS, not significant; ND, not determined.
↵ c One patient had three different BSI; therefore, statistical analysis was performed considering only 9 BSI patients.
↵ d McCabe and Jackson groups used to classify the severity of the underlying disease (22).
↵ e Comorbidity scores determined according to the Charlson weighted index (6).
↵ f Three from bladder catheter.
↵ g One from bladder catheter.
- TABLE 3.
Clinical parameters, antimicrobial regimens, and treatment outcome of patients with BSI due to ESBL-N-PM and ESBL-P-PM strains
Isolate Age (yr) Sexa McCabe and Jackson groupb Charlson weighted indexc Severity of septicemia Empirical antimicrobial treatmentd Antimicrobial therapy administered after ID and AST resultsd Treatment outcome Patient outcome and comments Agent (daily dose) Adequate Agent Timing from BSI onset Duration (days) Daily dose 43/97 ESBL 83 F Nonfatal 2 Sepsis CRO (1,000 mg × 2) No CRO 4 days before 8 1,000 mg × 2 Partial response Transferred on day 8 to nursing home GEN First day 5 2,000 mg 1/98 ESBL 91 M Nonfatal 3 Sepsis CRO (1,000 mg) No N.c. First day 6 N.c. Failure Death on day 6 for causes attributable to BSI 405/01 ESBL 43 M Nonfatal 0 Sepsis AMC (1,000 mg × 3) Yes N.c. First day 9 N.c. Relapse Transferred on day 12 to clinic for rehabilitation 130/02 ESBL 77 M Nonfatal 5 Sepsis SAM (1,500 mg × 3) Yes MEM 3 days after 21 1,000 mg × 3 Complete response Discharged on day 46 AMK 3 days after 21 500 mg 629/02 ESBL 65 M Rapidly 7 Sepsis SAM (3,000 mg × 3) Yes N.c. 2 day before 6 N.c. Failure Death on day 4 for causes attributable to BSI AMK (500 mg × 3) 139/03 ESBLe 45 M Nonfatal 0 Sepsis CRO (2,000 mg) No N.c. First day 12 N.c. Relapse New BSI on day 12 309/03 ESBLe 45 M Nonfatal 0 Sepsis CRO (1,000 mg × 2) No SAM 3 days after 12 1,500 mg × 4 Partial response Recurrent UTIf; new BSI on day 42 463/03 ESBLe 45 M Nonfatal 0 Sepsis FEP (1,000 mg × 3) No N.c. First day 10 N.c. Failure Complete response when AMK (500 mg × 2) added on day 53 for 6 days 601/03 ESBL 81 M Ultimately 4 Septic shock TZP (2,250 mg × 3) Yes N.c. 2 days before 6 N.c. Failure Death on day 4 for causes attributable to BSI A19/03 ESBL 84 F Ultimately 6 Severe sepsis CAZ (2,000 mg × 3) Yes IPM 4 days after 12 1,000 mg × 3 Complete response Transferred on day 21 to nursing home CIP (400 mg × 3) A68/03 ESBL 71 M Ultimately 7 Severe sepsis CAZ (1,000 mg × 3) No CAZ 1 day before 13 2,000 mg × 2 Complete response Discharged on day 13 AMK 2 days after 10 500 mg × 2 65/99 77 F Nonfatal 2 Sepsis CRO (2,000 mg) Yes N.c. 1 day before 10 N.c. Complete response Transferred on day 11 to nursing home 1289/01 61 F Rapidly 9 Sepsis CRO (2,000 mg) Yes CIP 5 days after 9 400 mg × 3 Partial response Complete response after IMP (1,000 mg × 3) use; death on day 24 2501/01 92 F Ultimately 7 Severe sepsis SAM (1,500 mg × 3) Yes N.c. First day 9 N.c. Complete response Discharged on day 10 AMK (500 mg) 2512/01 52 M Rapidly 5 Sepsis SAM (3,000 mg × 3) Yes N.c. 1 day before 8 N.c. Complete response Discharged on day 10 108/02 62 M Nonfatal 2 Septic shock IPM (1,000 mg × 4) Yes N.c. 10 days before 19 N.c. Complete response Discharged on day 90 AMK (1,000 mg) 461/02 63 F Ultimately 6 Severe sepsis CRO (2,000 mg) Yes IPM 5 days after 8 1,000 mg × 2 Complete response Discharged on day 26 LVX (500 mg × 3) 683/02 16 M Nonfatal 0 Sepsis CRO (1,000 mg × 2) Yes N.c. First day 6 N.c. Complete response Discharged on day 6 794/02 69 M Nonfatal 5 Sepsis None No IPM 1 day after 7 500 mg × 2 Complete response Patient submitted to day hospital for dialysis 85/03 73 M Nonfatal 2 Sepsis TZP (2,250 mg × 3) Yes CAZ 2 days after 16 2,000 mg × 3 Complete response Discharged on day 20 654/03 61 F Ultimately 8 Sepsis TZP (2,250 mg × 3) Yes N.c. 1 day before 15 N.c. Complete response Discharged on day 25 753/03 77 M Nonfatal 3 Sepsis TZP (2,250 mg × 3) Yes N.c. 1 day after 12 N.c. Complete response Discharged on day 8 A48/03 78 F Nonfatal 2 Sepsis CRO (2,000 mg) Yes N.c. First day 7 N.c. Complete response Transferred on day 15 to clinic for rehabilitation 134/04 77 M Ultimately 4 Sepsis None No None None None None Not assessable Death on day 1 634/04 84 F Nonfatal 3 Sepsis TZP (2,250 mg × 3) N.c. 1 day before 9 N.c. Complete response Discharged on day 10 ↵ a F, female; M, male.
↵ b McCabe and Jackson groups used to classify the severity of the underlying disease (22).
↵ c Comorbidity scores determined according to the Charlson weighted index (6).
↵ d Antimicrobial agent abbreviations: CRO, ceftriaxone; GEN, gentamicin; AMC, amoxicillin plus clavulanate; SAM, ampicillin plus sulbactam; MEM, meropenem; AMK, amikacin; FEP, cefepime; TZP, piperacillin plus tazobactam; CAZ, ceftazidime; CIP, ciprofloxacin; IPM, imipenem; LVX, levofloxacin. 1,000 mg × 2, two 1,000-mg doses. N.c., not changed.
↵ e These cases occurred in the same patient.
↵ f UTI, urinary tract infection.