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Table 1 Demographic characteristics, clinical features, treatment and outcome of case patients

From: A recurrent and transesophageal echocardiography–associated outbreak of extended-spectrum β-lactamase–producing Enterobacter cloacae complex in cardiac surgery patients

Case No.a Age (yrs) Sex Type of surgery Need for revisionb Type of infection Postoperative days to infectionc Sample typesd Treatmente Outcomef
1 42 M LVAD implantation No Pneumonia 28 Sputum, oropharynx, chest tube insertion site, stool, sacral decubitus ulcer TZP Discharge
2 55 M Aortic dissection repair Yes Pneumonia 2 (1) Endotracheal aspirate, sputum, oropharynx, stool TZP, MEM Discharge
3 75 F Aortic valve replacement Yes Pneumonia 2 (2) Sputum, endotracheal aspirate, stool MEM Discharge
4 53 M LVAD implantation, tricuspid annuloplasty Yes (twice) CRBSI 12 (7; 6) Blood, CVC tip, oropharynx, stool TZP, MEM, CVC removal Death
5 80 M CABG No Sternal wound infection, mediastinitis 5 Sternal wound fluid, sternal and mediastinal debridement samples MEM, sternal and mediastinal debridement Dischargeg
6 72 F Mitral valve replacement, tricuspid annuloplasty, maze procedure, PFO closure, LAA exclusion No Pneumonia 3 Endotracheal aspirate, oropharynx, BAL fluid, stool TZP Discharge
7 78 F CABG, aortic valve replacement No Pneumonia, CRBSI 3 Endotracheal aspirate, blood, CVC tip, AC insertion site, stool TZP, MEM, CVC removal Death
8 86 F Aortic dissection repair Yes Pneumonia 2 (1) Oropharynx, sputum, stool MEM Discharge
9 <.1 F Aortic coarctation repair, pulmonary artery banding Yes Tracheo-bronchitis 14 (14) Oropharynx, endotracheal aspirate TZP Discharge
10 .3 M ASD closure, mitral valvuloplasty No Pneumonia 4 Oropharynx, endotracheal aspirate, stool, urine TZP Discharge
11 33 M Heart transplantation No Inguinal wound infectionh 41 Stool, inguinal wound fluid Local wound care Discharge
12 <.1 M Blalock-Taussig shunt placement No Pneumonia 7 Oropharynx TZP, MEM Discharge
13 83 F Mitral valve replacement Yes Pneumonia, sepsis 2 (1) Oropharynx, endotracheal aspirate, blood, stool MEM Death
14 60 M CABG, mitral annuloplasty No Colonizationi – Oropharynx, endotracheal aspirate – Death
15 46 F Bilateral pulmonary embolectomy Yes Pneumonia, UTI 3 (2) Oropharynx, endotracheal aspirate, stool, urine TZP, MEM, nitrofurantoinj Discharge
16 62 F Aortic valve replacement No Infectious exacerbation of COPD 2 Sputum, stool MEM Discharge
17 64 M Aortic valve replacement, mitral annuloplasty No Pneumonia, sepsis, sternal wound infection 1 Oropharynx, blood, sternal wound fluid MEM, moxifloxacin, local wound carek Discharge
18 75 M Aortic valve bioprosthesis replacement, ascending aorta replacement Yes Pneumonia 16 (16)l Oropharynx, stool MEM Discharge
  1. Abbreviations: AC arterial catheter, ASD atrial septal defect, BAL bronchoalveolar lavage, CABG coronary artery bypass grafting, COPD chronic obstructive pulmonary disease, CRBSI catheter-related bloodstream infection, CVC central venous catheter, ESBL extended-spectrum β-lactamase, LAA left atrial appendage, LVAD left ventricular assist device, MEM meropenem, PFO patent foramen ovale, TZP piperacillin–tazobactam, UTI urinary tract infection
  2. aCases are numbered in chronological order of occurrence. Dashed lines separate the different outbreak episodes
  3. bPostoperative need for urgent reoperation because of bleeding with imminent or manifest pericardial tamponade or because of severe ventricular dysfunction
  4. cNumber of days between cardiac surgery and collection of the first clinical sample positive for ESBL-producing E. cloacae complex. In case of cardiac surgery followed by revision operation(s), values between brackets indicate days between revision operation and infection
  5. dAll types of clinical and screening specimens from which ESBL-producing E. cloacae complex was isolated
  6. eWhen both TZP and MEM are listed, TZP was given first and was later replaced by MEM because of antimicrobial susceptibility testing results or treatment failure
  7. fOutcome of the hospital stay. Deaths reflect overall mortality (see text for details on attributable mortality)
  8. gCase #5 had to be readmitted after discharge because of relapse of the sternal and mediastinal infection. Retreatment consisted of operative interventions and a prolonged course of high-dose MEM followed by a course of oral trimethoprim–sulfamethoxazole. Full recovery was achieved at the end of the second admission
  9. hCase #11 developed postoperative pneumonia caused by an E. cloacae complex strain that did not produce ESBL according to double disk synergy testing. An inguinal wound infection following percutaneous femoral vein catheterization occurred later in the postoperative period. An ESBL-producing E. cloacae complex strain was cultured from rectal swabs and inguinal wound fluid on postoperative day 19 and day 41, respectively
  10. iCase #14 died from low cardiac output and peripheral arterial disease on the third postoperative day, a few hours after the collection of two respiratory samples that turned out to be positive for ESBL-producing E. cloacae complex. The available time for developing an overt infection was limited in this patient. We classify this case as being colonized, but a beginning pneumonia cannot be excluded
  11. jCase #15 was first treated for pneumonia. TZP was given for 4 days and then switched to MEM for 10 days. The patient developed a UTI caused by ESBL-producing E. cloacae complex 2 weeks after MEM had been stopped, for which a course of nitrofurantoin was given
  12. kThe pneumonia and sepsis in case #17 were treated with MEM. This intravenous therapy was switched to oral moxifloxacin after 10 days, as prolonged treatment was needed for streptococcal endocarditis. Two superficial sternal wounds were primarily treated with local wound care, but the ESBL-producing E. cloacae complex in these wounds may also have responded well to moxifloxacin
  13. lCase #18 was treated postoperatively with TZP and linezolid for aortic valve bioprosthesis endocarditis. The TZP treatment may have delayed the development of full-blown pneumonia
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Antimicrobial Resistance & Infection Control

ISSN: 2047-2994

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