[Medline]. Enterobacter aerogenes and Enterobacter cloacae; versatile bacterial pathogens confronting antibiotic treatment. Resistance to carbapenems in Enterobacter is rare (1% of NNIS isolates in 1999) (19), presumably because Enterobacterisolates require two separate mutations to acquire carbapenem resistance: loss of porin proteins plus hyperproduction of beta-lactamase (34). Outbreaks have been traced to various common sources: total parenteral nutrition solutions, isotonic saline solutions, albumin, digital thermometers, and dialysis equipment. This organism has been reported to cause community -acquired infection complicating severe trauma or crush injuries (1). Semin Cell Dev Biol 2001;12:215-23. Crit Care Med 2000;28:4356-64. [PubMed], 33. These rates range from 14-71%. Â. 79(1A):68-76. 2009 Sep. 23(3):665-81. The isolation rate was 9.5% (with enterococci, coagulase-negative staphylococci, S aureus, and P aeruginosa rates being 15.3%, 12.6%, 11.2%, and 10.3%, respectively). 28(2):181-3. Surveillance data and outbreak case reports from North and South America, Europe, and Asia indicate that these bacteria represent an important opportunistic pathogen among neonates and debilitated patients in ICUs. Pediatr Radiol. NHSN annual update: antimicrobial-resistant pathogens associated with healthcare-associated infections: annual summary of data reported to the National Healthcare Safety Network at the Centers for Disease Control and Prevention, 2006-2007. Enterobacter cloacae ist in der Lage, unterschiedliche Krankheitsbilder hervorzurufen, unter anderem Blutvergiftungen, sowie Entzündungen der Atemwege, der Haut, von Gewebe und Organen. 2007 Apr. Pintado V, San Miguel LG, Grill F, et al. Factors in the microbiologic diagnosis and assessment of Enterobacter infection include the following: The most important test to document Enterobacter infections is culture; when the patient presents with signs of systemic inflammation (eg, fever, tachycardia, tachypnea) with or without shock (eg, hypotension, decreased urinary output), blood cultures are mandatory, Direct Gram staining of the specimen is also useful, because it allows rapid diagnosis of an infection caused by gram-negative bacilli and helps in the selection of antibiotics with known activity against most of these bacteria, In the laboratory, growth of Enterobacter isolates is expected to be detectable in 24 hours or less; Enterobacter species grow rapidly on selective (ie, MacConkey) and nonselective (ie, sheep blood) agars. 13(2):49-53. [Full Text]. [Medline]. Souli M, Kontopidou FV, Papadomichelakis E, et al. Lockhart SR, Abramson MA, Beekmann SE, et al. Am J Infect Control. [Medline]. 59 (3):1802-5. A functional classification scheme for beta-lactamases and its correlation with molecular structure. Available at http://www.cdc.gov/ncidod/dhqp/pdf/guidelines/Isolation2007.pdf. Another gene required for induction of beta-lactamases is AmpG, which encodes an AmpG transmembrane protein. Antimicrobial therapy is indicated in virtually all Enterobacter infections. 162(2):185-90. Patient data is used to generate specific drug and dosing recommendations. Enterobacter lower respiratory tract infections can manifest identically to those caused by Streptococcus pneumoniae or other organisms. This difference was highly statistically significant compared to other agents. Studies for the evaluation of Enterobacter infections include the following: Fluid analysis, such as cells and differential, proteins, glucose, and, in some cases, pH, lactate dehydrogenase, and amylase; required for pleural, articular, pericardial, peritoneal, and cerebrospinal fluids, Urine analysis: Always indicated for urinary tract infections (UTIs). *Antibiotics received in the 2 weeks before the initial positive blood culture. Nosocomial bloodstream infections in US hospitals: analysis of 24,179 cases from a prospective nationwide surveillance study. Arch Intern Med. Donati L, Scamazzo F, Gervasoni M, et al. Infect Control Hosp Epidemiol. Cunha BA, McDermott B, Nausheen S. Single daily high-dose tigecycline therapy of a multidrug-resistant (MDR) Klebsiella pneumoniae and Enterobacter aerogenes nosocomial urinary tract infection. 29(5):518-27. [Medline]. The authors found that combination therapy resulted in much lower rates of emergence of resistance than monotherapy. A comparison of the effect of universal use of gloves and gowns with that of gloves alone on acquisition of vancomycin-resistant enterococci in a medical unit. Deshpande P, Rodrigues C, Shetty A, Kapadia F, Hedge A, Soman R. New Delhi Metallo-beta lactamase (NDM-1) in Enterobacteriaceae: treatment options with carbapenems compromised. 11:1461-1472. [Medline]. Maria D Mileno, MD Associate Professor of Medicine, Division of Infectious Diseases, The Warren Alpert Medical School of Brown University [5], Previous reports from the National Nosocomial Infections Surveillance System (NNIS) demonstrated that Enterobacter species caused 11.2% of pneumonia cases in all types of ICUs, ranking third after Staphylococcus aureus (18.1%) and P aeruginosa (17%). As previously noted, the prevalence of resistance to quinolones in Enterobacter grew significantly between 1994 and 2000, although 90% of strains remained susceptible in 2000. suppl_1:. Lo-Ten-Foe JR, de Smet AM, Diederen BM, et al. 1997;107:359-361. [PubMed], 2. Efficacy of ertapenem in the treatment of early ventilator-associated pneumonia caused by extended-spectrum beta-lactamase-producing organisms in an intensive care unit. 2009 Nov. 53(11):4924-6. [16, 17], The taxonomic reclassification of E sakazakii within a new genus "Cronobacter" within the Enterobacteriaceae was proposed in 2007. Enterobacter cloacae complex, commonly referred to as E. cloacae, is the most frequent Enterobacter group found in human clinical samples but is not a common causative agent of orthopedics implant infections .