Risk factors with the development of infection with tigecycline- and carbapenem-resistant Enterobacter cloacae.

Abstract

BackgroundTigecycline is regarded as a last resort treatment for carbapenem-resistant Enterobacter cloacae (CREC) infections, and increasing numbers of tigecycline- and carbapenem-resistant E. cloacae (TCREC) isolates have been reported in recent years. However, risk factors and clinical impacts of these isolates are poorly characterized.Patients and methodsWe conducted a retrospective case-case-control study of hospitalized patients with TCREC infection during the period 2012–2016 in Chongqing, China. Case patients with TCREC and those with CREC were compared to a control group with no E. cloacae infection. Multivariate logistic regression models were used to identify independent risk factors for acquiring TCREC and CREC.ResultsA total of 36 TCREC cases, 36 CREC cases, and 100 controls were enrolled in our study. Multivariable analysis indicated that nasal catheter (OR: 8.9; 95% CI: 1.1–75.2), exposure to penicillin (OR: 95.9; 95% CI: 8.9–1038.3), aminoglycosides (OR: 42.1; 95% CI: 2.1–830.6), and fluoroquinolones (OR: 18.6; 95% CI: 1.9–185.6) were independent predictors for acquiring TCREC. In addition, venous catheterization (OR: 12.2; 95% CI: 2.5–58.5), penicillin (OR: 30.8; 95% CI: 7.9–120.0), and broad-spectrum cephalosporin (OR: 5.0; 95% CI: 1.5–17.3) were independently associated with CREC acquisition.ConclusionReasonable antibiotic stewardship programs and surveillance are necessary to control the tigecycline resistance among high-risk patients.