Risk Factors of Death in Bloodstream Infections Caused by AmpC β-Lactamase-Producing Enterobacterales in Patients with Neoplasia

Figures & data

Figure 1 Description of the detection of the BSI episodes and patients selected to be included in the study.

Abbreviations: ^aBSI, blood stream infection; ^bESCPM, Enterobacter spp., Serratia spp., Citrobacter spp., Providencia spp., Morganella spp.

Table 1 Univariate and Multivariate Analysis of Risk Factors for 7-Day Death of 107 Episodes of Bloodstream Infection Caused by ESCPM Enterobacteria

	Univariate Analisys									Multivariate Analisys
Variable, n (%)	Total		7-Day Death		Survivors		RR	95% CI	P value	OR	95% CI	P value
	n: 107		n: 10		n: 97
Gender, male	71	(66.3)	7	(70.0)	64	(66.0)	1.01	0.89–1.15	0.99
Age, median (variation)	63.0	(18–88)	65.5	(27–78)	62.0	(18–88)			0.33
Charlson comorbidity index, median (variation)	2	(2–9)	3	(2–6)	2	(2–9)			0.51
2–5	85	(79.4)	9	(90.0)	76	(80.0)	1.06	0.93–1.20	0.68
6–9	20	(18.7)	1	(10.0)	19	(20.0)	0.94	0.83–1.06	0.68
BMI, median (variation) Kg/m^2	24.2	(14.7–43.2)	23.1	(18.4–28.7)	24.2	(14.7–43.2)			0.36
< 18.5 Kg/m^2	5	(4.7)	1	(10.0)	4	(4.1)	1.12	0.72–1.75	0.42
18.5–25 Kg/m^2	51	(47.6)	7	(70.0)	44	(50.0)	1.08	0.95–1.23	0.32
25–30 Kg/m^2	31	(29.0)	2	(20.0)	29	(29.9)	0.94	0.82–1.06	0.49
30–40 Kg/m^2	10	(9.34)	0	(0)	10	(10.3)	0.88	0.82–0.95	0.59
> 40 Kg/m^2	1	(1.0)	0	(0)	1	(1.0)	0.89	0.83–0.95	0.99
Neoplasm
Solid organ	71	(66.4)	7	(70.0)	64	(66.0)	1.01	0.89–1.15	0.99
Abdomen	42	(39.2)	4	(40.0)	38	(39.2)	1.00	0.88–1.13	0.99
Head-neck	13	(12.1)	1	(10.0)	12	(12.4)	0.97	0.82–1.16	0.99
Thorax	11	(10.3)	0	(0)	11	(11.3)	0.89	0.83–0.95	0.59
Nervous system	5	(4.7)	2	(20.0)	3	(3.1)	1.53	0.74–3.14	0.06*
Hematological	36	(33.6)	3	(30.0)	33	(34.0)	1.01	0.89–1.15	0.99
Lymphoma	15	(14.0)	2	(20.0)	13	(13.4)	1.05	0.85–1.29	0.62
Leukemia	15	(14.0)	0	(0)	15	(15.4)	0.89	0.82–0.95	0.35
Other^a	6	(5.6)	1	(10.0)	5	(5.1)	1.09	0.76–1.57	0.45
Patients with more than one BSI episode	4	(3.7)	0	(0)	4	(4.1)	0.90	0.84–0.96	0.99
Status of the neoplasm disease
Under treatment with possibility of cure	65	(60.7)	5	(50.0)	60	(61.9)	0.95	0.83–1.08	0.50
Under control	3	(2.8)	1	(10.0)	2	(2.1)	1.37	0.61–3.05	0.25*
Without a curative plan	39	(36.4)	4	(40.0)	35	(36.1)	1.01	0.89–1.15	0.99
Immunosuppressive therapies
Radiotherapy, in the last 6 months	8	(7.5)	2	(20.0)	6	(6.2)	1.22	0.81–1.83	0.16*
Corticosteroid therapy, in the last 30 days	51	(47.7)	6	(60.0)	45	(46.4)	1.04	0.92–1.18	0.52
Chemotherapy, in the last 12 months	47	(43.9)	3	(30.0)	44	(45.4)	0.94	0.83–1.06	0.50
Mucositis, 72 hours before or after BSI	10	(9.3)	0	(0)	10	(10.3)	0.89	0.83–0.95	0.59
Blood transfusion, 72 hours before or after BSI	32	(29.9)	2	(20.0)	30	(30.9)	0.94	0.83–1.06	0.72
Febrile neutropenia (< 1000 cel/mm^3)	16	(14.9)	1	(10.0)	15	(15.5)	0.96	0.83–1.10	0.99*
Severe neutropenia (< 500 cel/mm^3)	6	(5.6)	1	(10.0)	5	(5.2)	1.09	0.76–1.57	0.45
Profound neutropenia (< 100 cel/mm^3)	10	(9.3)	0	(0)	10	(10.3)	0.89	0.83–0.95	0.59
Prolonged neutropenia (> 7 days duration)	10	(9.3)	0	(0)	10	(10.3)	0.89	0.83–0.95	0.59
Necessity of life support in the ICU	33	(30.8)	4	(40.0)	29	(29.9)	1.07	0.93–1.23	0.26*	1.03	0.13–7.69	0.97
Septic shock	28	(26.2)	4	(40.0)	24	(24.7)	1.10	0.93–1.29	0.21
CRP, median (Variation) mg/dL	16.3	(0.7–53.1)	21.6	(9.3–46.8)	15.1	(0.7–53.1)			0.17*	2.46	0.22–27.90	0.46
Type of acquisition
Hospital^b	75	(70.1)	7	(70.0)	68	(70.1)	0.99	0.87–1.14	0.99
Intensive care unit^c	23	(21.5)	3	(30.0)	20	(20.6)	1.05	0.88–1.25	0.44
Surgical ward	30	(28.0)	3	(30.0)	27	(27.8)	1.01	0.87–1.16	0.99
Clinical ward	22	(20.6)	1	(10.0)	21	(21.6)	0.93	0.83–1.05	0.68
Health-care associated	23	(21.5)	3	(30.0)	20	(20.6)	1.05	0.88–1.25	0.44
Comunity	9	(8.4)	0	(0)	9	(9.3)	0.89	0.84–0.95	0.59
Secondary BSI	58	(54.2)	6	(60.0)	52	(53.6)	1.02	0.90–1.15	0.75
Abdomen	21	(19.6)	3	(30.0)	18	(18.6)	1.07	0.89–1.29	0.40
Lower airways	15	(14.1)	0	(0)	15	(15.5)	0.89	0.82–0.85	0.35
Urinary tract	12	(11.2)	2	(20.0)	10	(10.3)	1.09	0.84–1.42	0.31
Skin and soft tissue	9	(8.4)	1	(10.0)	8	(8.2)	1.02	0.80–1.29	0.99
Central nervous system	1	(0.9)	0	(0)	1	(1.0)	0.9	0.85–0.96	0.99
Primary BSI	49	(45.8)	4	(40.0)	45	(46.4)	1.02	0.90–1.15	0.75
Long-term catheter	15	(14.1)	0	(0)	15	(15.5)	0.89	0.82–0.95	0.35
Short-term catheter	14	(13.1)	1	(10.0)	13	(13.4)	0.97	0.82–1.14	0.99
Mucosal barrier injury	10	(9.3)	1	(10.0)	9	(9.3)	1.00	0.81–1.25	0.99
Indeterminate	10	(9.3)	2	(20.0)	8	(8.2)	1.14	0.83–1.57	0.23*
Polymicrobial BSI	17	(15.9)	0	(0)	17	(17.5)	0.88	0.82–0.95	0.35
MDR-ESCPM BSI^d	10	(9.3)	4	(40.0)	6	(6.2)	1.56	0.94–2.60	0.01*	21.62	1.81–258.51	0.01
Previous MDR colonization by	23	(21.5)	3	(30.0)	20	(20.6)	1.05	0.88–1.25	0.44
Carbapenem-resistant enterobacteriaceae	13	(12.1)	2	(20.0)	11	(11.3)	1.08	0.85–1.37	0.34
Carbapenem-resistant Acinetobacter spp.	8	(7.5)	0	(0)	8	(8.2)	0.89	0.84–0.96	0.99
Methicilin-resistant Staphylococcus aureus	8	(7.5)	0	(0)	8	(8.2)	0.89	0.84–0.96	0.99
3rd and 4th generation cephalosporin-resistant enterobacteriaceae	5	(4.7)	1	(10.0)	4	(4.1)	1.13	0.73–1.77	0.39
Other^e	4	(3.7)	0	(0)	4	(4.1)	0.90	0.84–0.96	0.99
Empirical therapy	104	(97.2)	9	(90.0)	95	(97.9)	1.37	0.61–3.05	0.25
Monotherapy	82	(76.6)	8	(80.0)	74	(76.3)	1.01	0.89–1.16	0.99
Piperacillin-tazobactam	31	(29.0)	5	(50.0)	26	(26.8)	1.11	0.94–1.31	0.14*	10.46	0.97–112.91	0.05
Cefepime	18	(16.8)	0	(0)	18	(18.6)	0.88	0.82–0.95	0.20*
Meropenem/Imipenem	16	(15.0)	2	(20.0)	14	(14.4)	1.04	0.85–1.26	0.64
Ciprofloxacin	7	(6.5)	1	(10.0)	6	(6.2)	1.06	0.77–1.44	0.50
Amoxicilin-clavulanate	5	(4.7)	0	(0)	5	(5.2)	0.9	0.84–0.96	0.99
Other^f	5	(4.7)	0	(0)	5	(5.2)	0.9	0.84–0.96	0.99
Combination therapy	25	(23.4)	2	(20.0)	23	(23.7)	1.01	0.89–1.16	0.99*
(Meropenem or Imipenem) + Polymyxin B	6	(5.6)	1	(10.0)	5	(5.2)	1.09	0.76–1.57	0.45
(Meropenem or Imipenem) + Vancomycin	4	(3.7)	0	(0)	4	(4.1)	0.90	0.84–0.96	0.99
Meropenem + Amikacin	3	(2.8)	0	(0)	3	(3.1)	0.90	0.84–0.96	0.99
Meropenem + Polymyxin B + Tigecycline	2	(1.9)	1	(10.0)	1	(1.0)	1.82	0.45–7.32	0.17
Other^g	10	(9.3)	0	(0)	10	(10.3)	0.89	0.83–0.95	0.59
Guided initial therapy	3	(2.8)	1	(10.0)	2	(2.1)	1.37	0.61–3.05	0.25*
Inappropriate initial therapy	50	(46.7)	4	(40.0)	46	(47.4)	1.02	0.91–1.16	0.74
Cause of Inappropriate initial therapy
Start date	23	(21.5)	1	(10.0)	22	(22.7)	0.93	0.83–1.04	0.68
Less than 48h treatment	21	(19.6)	2	(20.0)	19	(19.6)	1.00	0.85–1.16	0.99
Resistance	14	(13.1)	1	(10.0)	13	(13.4)	0.97	0.82–1.14	0.99
Other therapeutic approaches
Catheter withdrawal	15	(14.0)	1	(10.0)	14	(14.4)	0.96	0.83–1.12	0.99
Time (days) of catheter withdrawal after blood culture, median (variation)	4	(-2 -25)
Other approaches for BSI treatment^h	11	(10.3)	0	(0)	11	(11.3)	0.89	0.83–0.96	0.59

Notes: ^aMultiple myeloma (n:03), marrow aplasia (n:03); ^bInfection acquired during hospital stay; ^cAdult and postoperative; ^dEnterobacter spp. (n:06), Serratia spp. (n:03), Citrobacter spp. (n:01); ^eCarbapenem-resistant Pseudomonas spp. (n:02) and Vancomycin-resistant Enterococcus spp. (VRE) (n:02); ^fTigecycline (n:01), Ertapenem (n:01), Moxifloxacin (n:01), Oxacillin (n:02); ^gOne-time used combination therapy schemes; ^hCollection drainage (n:03), lumboperitoneal shunt (n:01), vesical tumor resection (n:01), radical cystectomy (n:01), laparotomy (n:02), tracheostomy (n:02), external ventricular shunt (n:01); *Selected variables for multivariate analysis.

Abbreviations: ESCPM, Enterobacter spp., Serratia spp., Citrobacter spp., Providencia spp., Morganella spp.; BSI, blood stream infection; ICU, intensive care unit; CRP, C-reactive protein; MDR, multidrug resistant.

Table 2 Univariate and Multivariate Analysis of Risk Factors for 30-Day Death of 107 Episodes of Bloodstream Infection Caused by ESCPM Enterobacteria

	Univariate Analisys									Multivariate Analisys
Variable, n (%)	Total		30-Day Death		Survivors		RR	95% CI	P value	OR	95% CI	P value
	n: 107		n: 23		n: 84
Gender, male	71	(66.3)	16	(69.6)	55	(65.5)	1.03	0.84–1.27	0.80
Age, median (variation)	63.0	(18–88)	64.0	(18–78)	61.0	(20–88)			0.43
Charlson comorbidity index, median (variation)	2	(2–9)	2	(2–6)	2	(2–9)			0.60
2–5	85	(79.4)	18	(78.2)	67	(79.8)	0.95	0.72–1.25	0.76
6–9	20	(18.7)	5	(21.7)	15	(17.8)	1.05	0.79–1.38	0.76
BMI, median (variation) Kg/m^2	24.2	(14.7–43.2)	23.6	(18.4–29.6)	24.7	(14.7–43.2)			0.26
< 18.5 Kg/m^2	5	(4.7)	1	(4.3)	4	(4.7)	0.96	0.61–1.52	0.99
18.5–25 Kg/m^2	51	(47.6)	16	(69.5)	35	(41.6)	1.27	1.02–1.57	0.03*
25–30 Kg/m^2	31	(29.0)	5	(21.7)	26	(30.9)	0.88	0.72–1.09	0.43
30–40 Kg/m^2	10	(9.34)	0	(0)	10	(11.9)	0.75	0.66–0.84	0.11
> 40 Kg/m^2	1	(1.0)	0	(0)	1	(1.2)	0.77	0.69–0.86	0.99
Neoplasm
Solid organ	71	(66.4)	15	(65.2)	56	(66.7)	0.98	0.79–1.21	0.99
Abdomen	42	(39.2)	9	(39.1)	33	(39.3)	0.99	0.81–1.22	0.99
Head-neck	13	(12.1)	3	(13.0)	10	(11.9)	1.02	0.74–1.40	0.99
Thorax	11	(10.3)	1	(4.3)	10	(11.9)	0.84	0.68–1.05	0.45
Nervous system	5	(4.7)	2	(8.7)	3	(3.6)	1.32	0.64–2.72	0.29
Hematological	36	(33.6)	8	(34.8)	28	(33.3)	0.98	0.79–1.21	0.99
Lymphoma	15	(14.0)	3	(13.0)	12	(14.3)	0.97	0.74–1.28	0.99
Leukemia	15	(14.0)	2	(8.7)	13	(15.5)	0.89	0.70–1.11	0.51
Other^a	6	(5.6)	3	(13.0)	3	(3.6)	1.60	0.71–3.59	0.11
Patients with more than one BSI episode	4	(3.7)	0	(0)	4	(78.5)	0.77	0.70–0.86	0.57
Status of the neoplasm disease
Under treatment with possibility of cure	65	(60.7)	10	(43.5)	55	(65.5)	0.81	0.65–1.02	0.09*
Under control	3	(2.8)	2	(8.7)	1	(1.2)	2.39	0.48–11.89	0.11
Without a curative plan	39	(36.4)	11	(47.8)	28	(33.3)	1.14	0.91–1.43	0.22
Immunosuppressive therapies
Radiotherapy, in the last 6 months	8	(7.5)	2	(8.7)	6	(7.1)	1.04	0.69–1.57	0.99
Corticosteroid therapy, in the last 30 days	51	(47.7)	12	(52.2)	39	(46.4)	1.03	0.84–1.27	0.81
Chemotherapy, in the last 12 months	47	(43.9)	9	(39.1)	38	(45.2)	0.94	0.77–1.15	0.64
Mucositis, 72 hours before or after BSI	10	(9.3)	1	(4.3)	9	(10.7)	0.86	0.68–1.08	0.68
Blood transfusion, 72 hours before or after BSI	32	(29.9)	6	(26.1)	26	(31.0)	0.95	0.77–1.17	0.79
Febrile neutropenia (< 1000 cel/mm3)	16	(14.9)	4	(17.4)	12	(14.3)	1.05	0.78–1.42	0.74*
Severe neutropenia (< 500 cel/mm^3)	6	(5.6)	2	(8.7)	4	(4.8)	1.18	0.66–2.11	0.60
Profound neutropenia (< 100 cel/mm^3)	10	(9.3)	2	(8.7)	8	(9.5)	0.97	0.70–1.35	0.99
Prolonged neutropenia (> 7 days duration)	10	(9.3)	3	(13.0)	7	(8.3)	1.13	0.74–1.72	0.44
Necessity of life support in the ICU	33	(30.8)	10	(43.5)	23	(27.4)	1.22	0.96–1.57	0.06*	2.18	0.77–6.14	0.13
Septic shock	28	(26.2)	8	(34.8)	20	(23.8)	1.18	0.92–1.53	0.15
CRP, median (Variation) mg/dL	16.3	(0.7–53.1)	20.6	(8.6–46.8)	14.2	(0.7–53.1)			0.02*
Type of acquisition
Hospital^b	75	(70.1)	14	(60.9)	61	(72.6)	0.88	0.69–1.12	0.30
Intensive care unit^c	23	(21.5)	6	(26.1)	17	(20.2)	1.07	0.82–1.40	0.57
Surgical ward	30	(28.0)	6	(26.1)	24	(28.6)	0.97	0.78–1.20	0.99
Clinical ward	22	(20.6)	2	(8.7)	20	(23.8)	0.82	0.69–0.99	0.14*
Health-care associated	23	(21.5)	6	(26.1)	17	(20.2)	1.07	0.82–1.40	0.57
Comunity	9	(8.4)	3	(13.0)	6	(7.1)	1.19	0.74–1.91	0.40
Secondary BSI	58	(54.2)	14	(60.9)	44	(52.4)	1.07	0.88–1.31	0.49
Abdomen	21	(19.6)	8	(34.8)	13	(15.5)	1.33	0.94–1.89	0.07*
Lower airways	15	(14.1)	1	(4.4)	14	(16.7)	0.81	0.68–0.97	0.18*
Urinary tract	12	(11.2)	3	(13.0)	9	(10.7)	1.05	0.74–1.48	0.71
Skin and soft tissue	9	(8.4)	2	(8.7)	7	(8.3)	1.01	0.70–1.45	0.99
Central nervous system	1	(0.9)	0	(0)	1	(1.2)	0.78	0.70–0.86	0.99
Primary BSI	49	(45.8)	9	(39.1)	40	(47.6)	1.07	0.88–1.31	0.49
Long-term catheter	15	(14.1)	1	(4.4)	14	(16.7)	0.81	0.68–0.97	0.18*
Short-term catheter	14	(13.1)	1	(4.4)	13	(15.5)	0.82	0.68–0.98	0.29
Mucosal barrier injury	10	(9.3)	4	(17.4)	6	(7.1)	1.34	0.80–2.24	0.21*
Indeterminate	10	(9.3)	3	(13.0)	7	(8.3)	1.13	0.74–1.72	0.44
Polymicrobial BSI	17	(15.9)	1	(4.4)	16	(19.0)	0.80	0.67–0.94	0.11*
MDR-ESCPM BSI^d	10	(9.3)	5	(21.7)	5	(6.0)	1.62	0.87–3.04	0.03*
Previous MDR colonization by	23	(21.5)	7	(30.4)	16	(19.0)	1.16	0.87–1.55	0.25*
Carbapenem-resistant enterobacteriaceae	13	(12.1)	3	(13.0)	10	(11.9)	1.02	0.74–1.40	0.99
Carbapenem-resistant Acinetobacter spp.	8	(7.5)	2	(8.7)	6	(7.1)	1.05	0.69–1.58	0.68
Methicilin-resistant Staphylococcus aureus	8	(7.5)	2	(8.7)	6	(7.1)	1.05	0.69–1.58	0.68
3rd and 4th generation cephalosporin-resistant enterobacteriaceae	5	(4.7)	1	(4.4)	4	(4.8)	0.98	0.62–1.53	0.99
Other^e	4	(3.7)	2	(8.7)	2	(2.4)	1.59	0.59–4.26	0.20
Empirical therapy	104	(97.2)	22	(95.6)	82	(97.6)	1.18	0.52–2.64	0.51
Monotherapy	82	(76.6)	16	(69.6)	66	(78.6)	0.89	0.68–1.16	0.40
Piperacillin-tazobactam	31	(29.0)	10	(43.5)	21	(25.0)	1.22	0.94–1.59	0.11*	2.73	0.96–7.70	0.05
Cefepime	18	(16.8)	0	(0)	18	(21.4)	0.74	0.65–0.83	0.01*
Meropenem/Imipenem	16	(15.0)	3	(13.0)	13	(15.5)	0.96	0.74–1.24	0.99
Ciprofloxacin	7	(6.5)	3	(13.0)	4	(4.8)	1.4	0.73–2.67	0.16*
Amoxicilin-clavulanate	5	(4.7)	0	(0)	5	(6.0)	0.77	0.69–0.86	0.58
Other^f	5	(4.7)	0	(0)	5	(6.0)	0.77	0.69–0.86	0.58
Combination therapy	25	(23.4)	7	(30.4)	18	(21.4)	0.89	0.68–1.16	0.40*
(Meropenem or Imipenem) + Polymyxin B	6	(5.6)	2	(8.7)	4	(4.8)	1.18	0.66–2.11	0.60
(Meropenem or Imipenem) + Vancomycin	4	(3.7)	1	(4.4)	3	(3.6)	1.04	0.59–1.86	0.99
Meropenem + Amikacin	3	(2.8)	1	(4.4)	2	(2.4)	1.18	0.52–2.64	0.51
Meropenem + Polymyxin B + Tigecycline	2	(1.9)	1	(4.4)	1	(1.2)	1.58	0.39–6.34	0.38
Other^g	10	(9.3)	2	(8.7)	8	(9.5)	0.97	0.70–1.35	0.99
Guided initial therapy	3	(2.8)	1	(4.4)	2	(2.4)	1.18	0.52–2.64	0.51
Inappropriate initial therapy	50	(46.7)	9	(39.1)	41	(48.8)	1.08	0.89–1.32	0.48*
Cause of Inappropriate initial therapy
Start date	23	(21.5)	4	(17.4)	19	(22.6)	0.93	0.75–1.16	0.77
Less than 48h treatment	21	(19.6)	3	(13.0)	18	(21.4)	0.89	0.72–1.10	0.55
Resistance	14	(13.1)	2	(8.7)	12	(14.3)	0.9	0.71–1.14	0.72
Other therapeutic approaches
Catheter withdrawal	15	(14.0)	1	(4.4)	14	(16.7)	0.81	0.68–0.97	0.18*
Time (days) of catheter withdrawal after blood culture, median (variation)	4	(-2 -25)
Other approaches for BSI treatment^h	11	(10.3)	2	(8.7)	9	(10.7)	0.97	0.70–1.35	0.99

Notes: ^aMultiple myeloma (n:03), marrow aplasia (n:03); ^bInfection acquired during hospital stay; ^cAdult and postoperative; ^dEnterobacter spp. (n:06), Serratia spp. (n:03), Citrobacter spp. (n:01); ^eCarbapenem-resistant Pseudomonas spp. (n:02) and Vancomycin-resistant Enterococcus spp. (VRE) (n:02); ^fTigecycline (n:01), Ertapenem (n:01), Moxifloxacin (n:01), Oxacillin (n:02); ^gOne-time used combination therapy schemes; ^hCollection drainage (n:03), lumboperitoneal shunt (n:01), vesical tumor resection (n:01), radical cystectomy (n:01), laparotomy (n:02), tracheostomy (n:02), external ventricular shunt (n:01); *Selected variables for multivariate analysis.

Abbreviations: ESCPM, Enterobacter spp., Serratia spp., Citrobacter spp., Providencia spp., Morganella spp.; BSI, blood stream infection; ICU, intensive care unit; CRP, C-reactive protein; MDR, multidrug resistant.

Table 3 The Frequency of Antimicrobial Resistance of 108^a ESCPM Enterobacteria Isolated in 107 Episodes of Bloodstream Infection in Patients with Neoplasia

Antibiotic, n (%)	Total: 108^a		Enterobacter spp.^b n: 49 (45.4)		Serratia spp.^c n: 34 (31.5)		Morganella spp.^d n: 16 (14.9)		Citrobacter spp.^e n: 7 (6.5)		Providencia spp.^f n: 2 (1.8)
Sulfametoxazol-trimetoprim	23	(21.3)	8	(16.3)	3	(8.8)	9	(56.2)	2	(28.6)	1	(50.0)
Ciprofloxacin	15	(13.9)	9	(18.4)	3	(8.8)	1	(6.2)	2	(28.6)	0	(0)
Cefepime	13	(12.0)	9	(18.4)	3	(8.8)	0	(0)	1	(14.3)	0	(0)
Piperacillin/tazobactam	13	(12.0)	11	(22.4)	1	(2.9)	0	(0)	1	(14.3)	0	(0)
Gentamicin	11	(10.2)	6	(12.2)	0	(0)	2	(12.5)	1	(14.3)	2	(100.0)
Ertapenem	10	(9.2)	6	(12.2)	3	(8.8)	0	(0)	1	(14.3)	0	(0)
Imipenem	8	(7.4)	3	(6.1)	2	(5.9)	1	(6.2)	1	(14.3)	1	(50.0)
Tigecycline	7	(6.5)	4	(8.2)	3	(8.8)	*	*	0	(0)	*	*
Meropenem	6	(5.6)	3	(6.1)	3	(8.8)	0	(0)	0	(0)	0	(0)
Amikacin	4	(3.7)	2	(4.1)	2	(5.9)	0	(0)	0	(0)	0	(0)
Polymyxin B	0	(0)	0	(0)	*	*	*	*	0	(0)	*	*

Notes: ^aOne polymicrobial BSI had two ESCPM germs: E. aerogenes and C. koseri; ^bE. cloacae (n: 37), E. aerogenes (n: 07), E. spp. (n: 05); ^cS. marcescens (n: 32), S. liquefaciens (n: 01), S. odorifera (n: 01); ^dM. morganii (n: 16); ^eC. freundii (n: 03), C. koseri (n: 03), C. farmeri (n: 01); ^fP. rettgeri (n: 01), P. spp. (n: 01); *Non-tested: intrinsic resistance.

Abbreviations: ESCPM, Enterobacter spp., Serratia spp., Citrobacter spp., Providencia spp., Morganella spp.; BSI, bloodstream infection.