{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,18]],"date-time":"2026-09-18T12:01:03Z","timestamp":1789732863730,"version":"4.0.1"},"reference-count":36,"publisher":"American Society for Microbiology","issue":"8","license":[{"start":{"date-parts":[[2007,8,1]],"date-time":"2007-08-01T00:00:00Z","timestamp":1185926400000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.asm.org\/non-commercial-tdm-license"}],"content-domain":{"domain":["journals.asm.org"],"crossmark-restriction":true},"short-container-title":["J Clin Microbiol"],"published-print":{"date-parts":[[2007,8]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n          <jats:p>\n            <jats:italic>Enterobacter cloacae<\/jats:italic>\n            has been associated with several outbreaks, usually involving strains that overproduce chromosomal \u03b2-lactamase or, uncommonly, strains expressing extended-spectrum \u03b2-lactamases (ESBL). Only sporadic cases of ESBL-producing\n            <jats:italic>E. cloacae<\/jats:italic>\n            have been identified in our hospital in recent years. We describe the epidemiology and clinical and microbiological characteristics of an outbreak caused by ESBL-producing\n            <jats:italic>E. cloacae<\/jats:italic>\n            in a cardiothoracic intensive care unit (CT-ICU). Prospective surveillance of patients with infection or colonization by ESBL-producing\n            <jats:italic>E. cloacae<\/jats:italic>\n            among patients admitted to the CT-ICU was performed during the outbreak. Production of ESBL was determined by decreased susceptibility to expanded-spectrum cephalosporins and a positive double-disk test result. Clone relatedness was determined by pulsed-field gel electrophoresis (PFGE). From July to September 2005, seven patients in the CT-ICU with ESBL-producing\n            <jats:italic>E. cloacae<\/jats:italic>\n            were identified (four males; median age, 73 years; range, 45 to 76 years); six patients had cardiac surgery. Four patients developed infections; three had primary bacteremia, one had ventilator-associated pneumonia, and one had tracheobronchitis. ESBL-producing\n            <jats:italic>E. cloacae<\/jats:italic>\n            showed resistance to quinolones and aminoglycosides. PFGE revealed two patterns. Five isolates belonged to clone A; two carried a single ESBL (pI 8.2 and a positive PCR result for the SHV type), and three carried two ESBLs (pIs 8.1 and 8.2 and positive PCR results for the SHV and CTX-M-9 types). Isolates belonging to clone B carried a single ESBL (pI 5.4 and a positive PCR result for the TEM type). Review of antibiotic consumption showed increased use of cefepime and quinolones during June and July 2005. The outbreak was stopped by the implementation of barrier measures and cephalosporin restriction. ESBL production could be increasingly common in nosocomial pathogens other than\n            <jats:italic>Escherichia coli<\/jats:italic>\n            or\n            <jats:italic>Klebsiella pneumoniae<\/jats:italic>\n            .\n          <\/jats:p>","DOI":"10.1128\/jcm.02546-06","type":"journal-article","created":{"date-parts":[[2007,6,21]],"date-time":"2007-06-21T01:44:31Z","timestamp":1182390271000},"page":"2365-2369","update-policy":"https:\/\/doi.org\/10.1128\/asmj-crossmark-policy-page","source":"Crossref","is-referenced-by-count":42,"title":["Nosocomial Outbreak Due to Extended-Spectrum-Beta-Lactamase- Producing\n            <i>Enterobacter cloacae<\/i>\n            in a Cardiothoracic Intensive Care Unit"],"prefix":"10.1128","volume":"45","author":[{"given":"Adriana","family":"Manzur","sequence":"first","affiliation":[{"name":"Infectious Diseases Service"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fe","family":"Tubau","sequence":"additional","affiliation":[{"name":"Microbiology Service"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Miquel","family":"Pujol","sequence":"additional","affiliation":[{"name":"Infectious Diseases Service"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Laura","family":"Calatayud","sequence":"additional","affiliation":[{"name":"Microbiology Service"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maria Angeles","family":"Dominguez","sequence":"additional","affiliation":[{"name":"Microbiology Service"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carmen","family":"Pen\u0303a","sequence":"additional","affiliation":[{"name":"Infectious Diseases Service"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mercedes","family":"Sora","sequence":"additional","affiliation":[{"name":"Pharmacy Service, Hospital Universitari de Bellvitge, Feixa Llarga, sn., L'Hospitalet de Llobregat, 08907 Barcelona, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Francesc","family":"Gudiol","sequence":"additional","affiliation":[{"name":"Infectious Diseases Service"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Javier","family":"Ariza","sequence":"additional","affiliation":[{"name":"Infectious Diseases Service"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"235","reference":[{"key":"e_1_3_1_2_2","doi-asserted-by":"publisher","DOI":"10.1128\/AAC.47.12.3989-3993.2003"},{"key":"e_1_3_1_3_2","doi-asserted-by":"publisher","DOI":"10.1007\/s10156-006-0452-0"},{"key":"e_1_3_1_4_2","first-page":"237","volume":"40","year":"2002","unstructured":"Cant\u00f3n, R., A. Oliver, M. T. Coque, C. Varela, J. C. Perez-D\u00edaz, and F. Baquero. 2002. Epidemiology of extended-spectrum \u03b2-lactamase-producing Enterobacter cloacae isolates in a Spanish hospital during a 12-year period. J. Clin. Microbiol.40:237-1243.","journal-title":"J. Clin. 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