Enterobacter cloacae Infection

E. cloacae is ubiquitous in feces, water, soil, and plants—normal gut flora but an opportunistic pathogen. With widespread cephalosporin use it has become an increasingly important nosocomial pathogen causing multiorgan infection (skin/soft tissue, UTI, respiratory, septicemia). It produces ESBLs and AmpC β-lactamase, causing serious resistance.

Common Symptoms

Ascites; tachypnea; septicemia; remittent fever; meningitis

Causes and Pathogenesis

E. cloacae is a Gram-negative short stout rod 0.6-1.1 × 1.2-3.0 µm, peritrichously flagellated (6-8), motile, non-spore, non-encapsulated; optimal at 30°C, facultatively anaerobic; large moist mucoid colonies on ordinary media, non-hemolytic on blood agar, pink/mucoid on EMB/MacConkey, white/mucoid on SS; ferments lactose/sucrose/sorbitol/raffinose/rhamnose/melibiose; ornithine decarboxylase (+), arginine dihydrolase (+), lysine decarboxylase (-), indole (-). Antigens: O/H/K (53 O groups, 56 H antigens, 79 serovars by Sakazaki). Pathogenesis: endotoxin, strong disinfectant/antibiotic resistance, and rapid β-lactam resistance acquisition. Predisposing factors: (1) local barrier breaks (burns, trauma, surgery, procedures); (2) immune defects (radiation, cytotoxics, immunosuppressants, viral infections); (3) invasive devices (catheters, endoscopes, ventilators); (4) ESBL/AmpC production. A Zhejiang study of 144 isolates: sensitivity to amoxicillin-clavulanate, cefuroxime, aztreonam, cefotaxime, ciprofloxacin, piperacillin-tazobactam, amikacin all <55%; cefoperazone-sulbactam/cefepime ~60%; only imipenem was 98.6% sensitive. High AmpC producers: 24.3%; ESBL producers: 36.8%. Broad-spectrum antibiotics suppress normal flora and select for resistant strains.

Treatment

Traditional Chinese medicine, supportive therapy

Preventive Measures

1. Skin/mucosal protection. 2. Ward disinfection; handwashing; transfer chronic carrier staff. 3. Rational antibiotic/steroid use; watch for fungal/resistant superinfection. 4. Aseptic technique during invasive procedures. 5. Control leukemia/diabetes/chronic liver disease.

Department to Visit

It is recommended to visit the Infectious Diseases department; an appointment can be booked on this platform before the visit.

Warm reminder: The above information is for health science reference only and cannot replace professional medical diagnosis. If you have related symptoms, please seek medical attention at a regular hospital promptly.