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

Figures & data

Table 1 Univariate analysis of risk factors for the acquisition of tigecycline resistance in patients with carbapenem-resistant or -susceptible E. cloacae

Variables	Patients (n=172)
	Case 1 (n=36)	Case 2 B(n=36)	Control (n=100)	Case 1 vs Case 2		Case 1 vs Control		Case 2 vs Control
				OR (95% CI)	P-value	OR (95% CI)	P-value	OR (95% CI)	P-value
Age (years), median (IQR)	70 (63, 83.8)	60 (47, 76.8)	60 (47, 75.8)	–	0.01	–	0.001	–	0.838
Length of stay(days), median (IQR)	29 (14, 29.8)	23 (9.3, 79)	21 (17, 54)	–	0.616	–	0.02	–	0.068
Elderly (≥60 years), n (%)	28 (77.8)	20 (55.6)	50 (50)	2.1 (0.8–5.6)	0.141	2.6 (1.1–6.0)	0.021	1.25 (0.6–2.7)	0.567
ICU stay, n (%)	18 (50)	14 (39)	24 (24)	1.3 (0.5–3.3)	0.578	3.2 (1.4–7.0)	0.004	2 (0.9–4.5)	0.088
Male, n (%)	11 (31)	8 (22)	52 (52)	0.6 (0.2–1.6)	0.279	2.5 (1.1–5.5)	0.027	3.8 (1.6–9.1)	0.002
Number of deaths, n (%)	1 (2.8)	3 (8.3)	0 (0)	0.3 (0.03–3.2)	0.303	1.0 (1.0–1.1)	0.094	1.1 (1–1.2)	0.004
Comorbidities
Chronic hepatitis, n (%)	6 (16.7)	5 (13.9)	15 (15)	1.2 (0.3–4.5)	0.743	1.1 (0.4–3.2)	0.812	0.9 (0.3–2.7)	0.872
Coronary heart diseases, n (%)	7 (19.4)	4 (11.1)	10 (10)	1.9 (0.5–6.9)	0.335	2.2 (0.8–6.2)	0.142	1.1 (0.3–3.8)	0.851
Diabetes, n (%)	14 (38.9)	7 (19.4)	19 (19)	1.2 (0.5–2.9)	0.169	2.7 (1.2–6.3)	0.017	1 (0.4–2.7)	0.954
Gastrointestinal disease, n (%)	4 (11.1)	4 (11.1)	24 (24)	1 (0.2–4.3)	1	0.4 (0.1–1.2)	0.101	0.4 (0.1–1.2)	0.101
Hypertension, n (%)	17 (47.2)	16 (44.4)	24 (24)	2.1 (0.7–5.9)	0.761	2.8 (1.3–6.3)	0.009	2.5 (1.1–5.6)	0.021
Kidney disease, n (%)	4 (11.1)	8 (22.2)	14 (14)	0.4 (0.1–1.6)	0.206	0.7 (0.2–2.2)	0.52	1.6 (0.6–4.1)	0.373
Invasive operation
Central venous catheterization, n (%)	15 (41.7)	10 (27.8)	4 (4)	1.8 (0.7–4.6)	0.242	17.1 (5.2–56.9)	<0.001	9.2 (2.7–31.8)	<0.001
Endotracheal intubation, n (%)	6 (16.7)	13 (36.1)	13 (13)	0.3 (0.1–0.9)	0.024	1.3 (0.5–3.8)	0.586	3.8 (1.5–9.3)	0.002
Mechanical ventilation, n (%)	11 (30.6)	6 (16.7)	13 (13)	1.8 (0.6–5.4)	0.312	2.9 (1.2–7.4)	0.018	1.3 (0.5–3.8)	0.586
Urinary catheterization, n (%)	25 (69.4)	13 (36.1)	36 (36)	4.6 (1.8–12.2)	0.001	4.0 (1.8–9.2)	0.001	1 (0.5–2.2)	0.99
Bladder irrigation, n (%)	9 (25)	0 (0)	3 (3)	–	0.003	10.8 (2.7–42.6)	<0.001	–	0.565
Nasogastric catheter, n (%)	17 (47.2)	10 (27.8)	15 (15)	1.8 (0.7–4.6)	0.242	5.1 (2.2–12.0)	<0.001	2.2 (0.9–5.4)	0.09
Nasal catheter, n (%)	18 (13.2)	10 (27.8)	7 (5.1)	2.6 (1.0–7.0)	0.05	13.3 (4.8–36.4)	<0.001	5.1 (1.7–14.7)	0.001
Antibiotic therapy
Penicillin, n (%)	18 (50)	17 (47.2)	8 (8)	0.9 (0.4–2.3)	0.846	11.5 (4.3–30.5)	<0.001	10.3 (3.9–27.2)	<0.001
Aminoglycosides, n (%)	9 (25)	3 (8.3)	3 (3)	3 (0.7–12.1)	0.111	10.8 (2.7–42.6)	<0.001	2.9 (0.6–15.3)	0.181
Broad-spectrum cephalosporins, n (%)	13 (36.1)	17 (47.2)	28 (28)	0.6 (0.2–1.5)	0.291	1.4 (0.6–3.1)	0.428	2.3 (1.1–5.1)	0.036
Carbapenems, n (%)	10 (27.8)	10 (27.8)	10 (10)	1 (0.4–2.8)	0.947	3.5 (1.3–9.2)	0.01	3.5 (1.3–9.2)	0.01
Fluoroquinolones, n (%)	10 (27.8)	3 (8.3)	9 (9)	4.4 (1.1–17.2)	0.024	3.9 (1.4–10.6)	0.005	0.9 (0.2–3.6)	0.904
Glycopeptides, n (%)	6 (16.7)	6 (16.7)	6 (6)	0.8 (0.2–2.8)	0.765	0.4 (0.1–1.3)	0.125	3.1 (1–10.4)	0.053
Macrolides, n (%)	1 (2.8)	0 (0)	1 (1)	0.5 (0.4–0.7)	0.352	2.8 (0.2–46.4)	0.447	0.9 (0.9–1.0)	0.547
Minocycline, n (%)	8 (22.2)	1 (2.8)	1 (1)	7 (0.8–60)	0.044	28.3 (3.4–235.9)	<0.001	2.8 (0.2–46.4)	0.447

Table 2 Multivariate logistic regression analysis of risk factors for the acquisition of tigecycline resistance in patients with carbapenem-resistant or -susceptible E. cloacae

Patients
Variables	Case 1 vs case 2		Case 1 vs control		Case 2 vs control
Multivariate analysis	OR (95% CI)	P-value	OR (95% CI)	P-value	OR (95% CI)	P-value
Nasal catheter, n (%)	6.0 (1.5–24.6)	0.012	8.9 (1.1–75.2)	0.044	–	–
Central venous catheterization, n (%)	–	–	–	–	12.2 (2.5–58.5)	0.002
Penicillin, n (%)	–	–	95.9 (8.9–1,038.3)	<0.001	30.8 (7.9–120.0)	<0.001
Broad-spectrum cephalosporin, n (%)	–	–	–	–	5.0 (1.5–17.3)	0.01
Fluoroquinolones, n (%)	9.1 (1.6–51.9)	0.012	18.6 (1.9–185.6)	0.013	–	–
Aminoglycosides, n (%)	–	–	42.1 (2.1–830.6)	0.014	–	–
Minocycline, n (%)	13.7 (1–189.8)	0.051	–	–	–	–

Notes: Case 1: patients with tigecycline- and carbapenem-resistant E. cloacae; case 2: patients with tigecycline-susceptible and carbapenem-resistant E. cloacae; and control: patients with tigecycline- and carbapenem-susceptible E. cloacae.

Figure 1 Comparison of tigecycline MICs in QN-S and QN-NS CREC isolates.

Abbreviations: CREC, carbapenem resistant E. cloacae; QN-S, fluoroquinolone-susceptible; QN-NS, fluoroquinolone-non-susceptible; TGC, tigecycline; MIC, minimum inhibitory concentration.

Figure 2 The timeline of the carbapenem-resistant E. cloacae TS.11 and the tigecycline- and carbapenem-resistant E. cloacae NO.27 isolated from the same patient.

Abbreviations: CAZ, ceftazidime; CREC, carbapenem resistant E. cloacae; FEP, cefepime; ITC, itraconazole; LEV, levofloxacin; TNZ, tinidazole.