1222. Impact of Microbiology Reporting Changes in Treatment of AmpC Bloodstream Infections
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Abstract Background Recent literature suggests that AmpC production may be overcalled in Enterobacterales, leading to unnecessary broad-spectrum antimicrobial utilization. The Infectious Diseases Society of America (IDSA) has since reassessed classification of high and low risk organisms with inducible AmpC expression. With this updated guidance, our health system approved changes to our microbiology reporting of AmpC producers in an effort to guide prescribing of appropriate antibiotics. The primary objective of this project was to compare antibiotic prescribing patterns for high and low risk AmpC producers in patients with bloodstream infections (BSI) based on the addition of appended comments to antimicrobial susceptibility results. Methods This multicenter, retrospective, cohort study included patients with BSI from October 2022 to March 2023who received at least 48 hours of antimicrobial therapy for the following high and low risk AmpC producers: Citrobacter spp., Enterobacter spp., Klebsiella aerogenes, Serratia spp., Morganella spp., Providencia spp. The primary endpoint was the number of patients placed on optimal therapy based on adherence to the appended microbiology comment and IDSA guidance. Secondary endpoints included time to effective treatment, time to optimal treatment, duration of therapy, 30 day mortality, microbiological failure, microbiological relapse, 30 day readmission, length of stay, and hospital acquired Clostridioides difficile infection. Results A total of 191 positive blood cultures were identified with 93 patients (pre-appended comment = 57; post-appended comment = 36) meeting inclusion criteria. Patients were more likely to receive optimal therapy post-appended comment based on IDSA guidance for BSI (38.6% vs 72.2%, OR 4.14; 1.68-10.21). When stratified by high risk and low risk organism, the number of patients on optimal therapy increased in the post-appended comment group but was not statistically significant (high risk: 70.3% vs 88%, OR 3.08; 0.72-13.32; low risk: 10% vs 36.3%, 5.14; 0.92-28.50). No difference in secondary outcomes were detected. Conclusion Implementation of an appended microbiology note has the potential to have a positive impact on antimicrobial prescribing patterns in treatment of AmpC bloodstream infections. Disclosures All Authors: No reported disclosuresKeywords:
Citrobacter
Clinical endpoint
Enterobacter aerogenes
The authors isolated two strains of an unnamed bacterial biotype with characteristics intermediate between those of Enterobacter and Citrobacter. The organisms did not produce acetyl-methyl carbinol, but decarboxylated lysine. Apart from the latter trait, they most closely resemble H2S-negative Citrobacter freundii. They differ biochemically from all other currently accepted species of enterobacteriaceae. Their pathogenic significance appears similar to that of the two genera they most closely resemble. Only by recognition and study of additional strains can their identity be more definitively delineated and their significance more fully assessed.
Citrobacter
Citrobacter freundii
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Enterobacter aerogenes was recently renamed Klebsiella aerogenes . This study aimed to identify differences in clinical characteristics, outcomes, and bacterial genetics among patients with K. aerogenes versus Enterobacter species bloodstream infections (BSI). We prospectively enrolled patients with K. aerogenes or Enterobacter cloacae complex ( Ecc ) BSI from 2002 to 2015.
Enterobacter aerogenes
Enterobacter cloacae
Klebsiella
Bloodstream infection
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A total of 74 Enterobacter species have been isolated from the patients applying to the department of Microbiology, University of Ankara, Studying several biochemical test systems their strains have been found. 37 of these Enterobacter species have been found to be Enterobacter cloacae, 10 Enterobacter agglomerans, 13 Enterobacter aerogenes, 3 Enterobacter hafniae (Hafnia alvei), 1 Enterobacter sakazakii. 2 of the strains couldn't be classified. In conclusion most of the strains were found to be Enterobacter cloacae.
Enterobacter cloacae
Enterobacter aerogenes
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The comparative study of adhesive, hemolytic, DNA-ase, lecithinase, antilysozymic, anticomplementary activities of mono- and associated cultures of 57 Enterobacter spp., 61 Citrobacter spp. and 55 Serratia spp. strains, isolated from patients with pyoinflammatory, intestinal and urological diseases is carried out. Different variations of cocultivated bacteria including Enterobacter and Citrobacter, Enterobacter and Serratia, Citrobacter and Serratia are used. It was shown, that cocultivated Enterobacter, Citrobacter and Serratia bacteria increased the persistent properties of mixt cultures.
Citrobacter
Serratia
Enterobacteriaceae Infections
Enterobacter cloacae
Klebsiella
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A total of 139 consecutive and non-duplicate bloodstream isolates of Enterobacter spp. collected from inpatients in Hong Kong during 2000-2002 were studied for production of extended-spectrum beta-lactamases (ESBLs).All isolates were evaluated by the modified double-disc synergy test (m-DDST), the combined disc method (CDM) and the three-dimensional (3D) test. The m-DDST and CDM were modified by the use of cefepime discs. beta-Lactamases were characterized by isoelectric focusing and PCR sequencing using specific primers.ESBLs were identified in nine isolates (overall 6.5%), including seven of 39 (17.9%) Enterobacter hormaechei, one of 27 (3.7%) Enterobacter aerogenes and the only Enterobacter intermedius strain. The E. intermedius strain was positive only in the 3D test but not in the other two tests. The other eight strains were positive in all three tests. No ESBL was detected in the other species, including non-hormaechei members of the Enterobacter cloacae complex (n=61), Enterobacter agglomerans (n=7), Enterobacter gergoviae (n=4) and Enterobacter sakazakii (n=1). The ESBL content included five different CTX-M enzymes (CTX-M-9, CTX-M-13, CTX-M-14, CTX-M-24 and a novel CTX-M-2-like beta-lactamase), SHV-12 (n=2) and unidentifiable ESBLs with a pI of 7.7 or 7.9 in two strains. The seven ESBL-producing E. hormaechei were genotyped by pulsed-field gel electrophoresis and were found to be unrelated to each other. In three of the CTX-M-producing strains, ISEcp1-like elements, including promoters for the beta-lactamase gene, were found.Our data underscore the diversity of CTX-M enzymes among Enterobacter spp. in Hong Kong.
Enterobacter aerogenes
Enterobacter cloacae
Cefepime
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Background: Clinical significance of Extended-Spectrum Beta-Lactamases (ESBLs) production in Enterobacter spp. has not well been established. Objectives: This study was conducted to investigate the prevalence of ESBLs produced by Enterobacter spp. in clinical isolates. Materials and Methods: This descriptive cross-sectional study was performed during May 2010 to April 2012 in the city of Sanandaj, Kurdistan province, Iran. We did not include and directly contact the patient population, yet had access to two thousand patient specimens (urine, wound, respiratory tube, blood, cerebrospinal fluid and stool), which were collected from patients that had referred to various departments of two government hospitals of Toohid and Besat. As a result, 118 Enterobacter spp. isolates were identified and considered. The Clinical and laboratory standard institute (CLSI) Combined Disk Test (CDT) and polymerase chain reaction (PCR) were applied for detecting Enterobacter spp. Data were analyzed using the SPSS 11.5 software, Chi-square (x2) test and a Kappa coefficient (κ) (P < 0.05). Results: Out of 118 Enterobacter spp. isolates, 31.36% were Enterobacter aerogenes (E. aerogenes), 20.34% Enterobacter agglomerans (E. agglomerans), 12.71% Enterobacter cloacae (E. cloacae), and 33.90% were other Enterobacter spp. All 118 (100%) Enterobacter isolates produced ESBLs. In the detection of ESBLs, CDT and PCR results were similar to each other and all 118 Enterobacter spp. were ESBLs producers (κ = 1). Conclusions: According to the results, most of the Enterobacter spp. produced ESBLs and were Cefotaxime-M (CTX-M) enzyme carriers. Guidelines and appropriate use of antibiotics are necessary to avoid the production of ESBLs.
Enterobacter aerogenes
Enterobacter cloacae
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ABSTRACT Citrobacter spp., Enterobacter spp., and Klebsiella spp. isolated from the human gut were investigated for the biosynthesis of cellulose and curli fimbriae ( csg ). While Citrobacter spp. produced curli fimbriae and cellulose and Enterobacter spp. produced cellulose with various temperature-regulatory programs, Klebsiella spp. did not show pronounced expression of those extracellular matrix components. Investigation of multicellular behavior in two Citrobacter species and Enterobacter sakazakii showed an extracellular matrix, cell clumping, pellicle formation, and biofilm formation associated with the expression of cellulose and curli fimbriae. In those three strains, the csgD-csgBA region and the cellulose synthase gene bcsA were conserved. PCR screening for the presence of csgD, csgA and bcsA revealed that besides Klebsiella pneumoniae and Klebsiella oxytoca, all species investigated harbored the genetic information for expression of curli fimbriae and cellulose. Since Citrobacter spp., Enterobacter spp., and Klebsiella spp. are frequently found to cause biofilm-related infections such as catheter-associated urinary tract infections, the human gut could serve as a reservoir for dissemination of biofilm-forming isolates.
Citrobacter
Klebsiella
Klebsiella oxytoca
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Samples of water, soil, needles, and bark were collected from three different forest environments and from a pulp and paper mill. In addition, samples of fresh produce were obtained from a local supermarket. All samples were examined for total and fecal coliforms. The counts obtained from the forestrelated samples did not correlate with sample type or location. When 123 isolates were identified biochemically, 71% were Klebsiella , 19% Enterobacter , 8% Citrobacter , and 2% Escherichia . All the Citrobacter , 75% of the Enterobacter , and 65% of the Klebsiella were negative for growth in elevated coliform (EC) broth. All the Escherichia were EC positive. The counts obtained from the fresh produce were generally higher than the forest counts, but the distribution of biotypes was similar. Of the 146 isolates examined 64% were Klebsiella , 14% were Escherichia , 14% were Enterobacter , and 8% were Citrobacter . All the Enterobacter and Citrobacter were EC negative, whereas 25% of the Klebesiella and 80% of the Escherichia were EC positive.
Citrobacter
Klebsiella
Escherichia
Pantoea
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A total of 1,013 isolates of Enterobacteriaceae were identified in parallel by the Repliscan (Cathra International, Ontario, Canada) and API 20E (Analytab Products, Plainview, N.Y.) systems. There was a 62% agreement at the genus level between the two systems. Of the 38% discrepant results, Repliscan classified 22% as "biochemical pattern not on file," 8% as a multiple-genus group which included the API 20E identification, and 8% as a genus other than that designated by API 20E. Relative to the various genera, Repliscan agreed with API 20E as follows: Escherichia coli, 80%; Klebsiella spp., 76%; Citrobacter spp., 75%; Proteus spp., 69%; Providencia spp., 54%; Serratia spp., 49%; Enterobacter spp., 25%; Shigella spp., 4%; and Salmonella spp., 0%. Repliscan identified 35% of Enterobacter spp. isolates as Citrobacter spp., 91% of Shigella spp. isolates as a multiple-choice-genus group, and 67% of Salmonella spp. isolates as "biochemical pattern not on file." Repliscan agreed with API 20E at the species level as follows: E. coli, 80%; Klebsiella spp., 56%; Citrobacter spp., 66%; Proteus spp., 55%; Providencia spp., 46%; Serratia spp., 39%; Enterobacter spp., 18%; Shigella spp., 4%; and Salmonella spp., 0%. These findings indicate that the Repliscan system in its present stage of development does not reliably identify the Enterobacteriaceae.
Citrobacter
Serratia
Providencia
Klebsiella
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We report here the draft genome sequences of four blaKPC-containing bacteria identified as Klebsiella aerogenes, Citrobacter freundii, and Citrobacter koseri Additionally, we report the draft genome sequence of a K. aerogenes strain that did not contain a blaKPC gene but was isolated from the patient who had the blaKPC-2-containing K. aerogenes strain.
Citrobacter freundii
Enterobacter aerogenes
Citrobacter
Strain (injury)
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