How Do You Get Enterobacter Cloacae Complex?

Although there are currently 22 Enterobacter species, not all are pathogenic to humans. Enterobacter cloacae complex (ECC) are common in nature, but they can act as pathogens (opportunistic) in some cases. ECC consists of six closely related species that exhibit similar resistance patterns. 

The family of ECC includes:

• E. cloacae
• E. asburiae
• E. hormaechei
• E. kobei
• E. ludwigii
• E. nimipressuralis

ECC is one of the most common pathogens in hospitals, frequently causing infections such as pneumonia, UTI, and sepsis. Multidrug-resistant ECC strains have emerged and spread throughout the world because of widespread antibiotic use. 

ECC infection accounts for 65%-75% of Enterobacter infections.

These bacteria can cause many infections in hospital and clinical settings:

• Respiratory infections
• Osteomyelitis (bone infection)
• Urinary tract infections (UTIs)
• Soft tissue infections
• Endocarditis (heart infection)
• Meningitis (brain infection)

Common signs and symptoms of Enterobacter cloacae complex (ECC) may include:

• Cough
• Shortness of breath
• Diarrhea
• Hypotension (low blood pressure)
• Fever
• Pneumonia
• Painful urination
• Urinary frequency and urgency
• Inflammation throughout the body (systemic inflammatory response)
• Leukocytosis (elevated white blood cell count)
• Shock

Antibiotic resistance is a growing issue in the treatment of Enterobacter cloacae complex (ECC) infections. Treatment options may include:

• Third-generation cephalosporins
  • May be successful against some strains of Enterobacter but can result in multiresistant infection
  • Due to the increased risk of resistance, third-generation cephalosporins are not advised for use in severe ECC infections
• Fourth-generation cephalosporins
  • Acceptable treatment option for ECC because they are stable enough to not cause resistance
  • However, some species may render third- and fourth-generation cephalosporins ineffective
• Carbapenems (meropenem and imipenem)
  • The most effective therapies for multidrug-resistant ECC infections
  • However, resistance to carbapenems has been developing in recent years
• Treatment for carbapenem-resistant Enterobacter (CRE)
  • Extremely complex treatment, with a high degree of variability and requiring numerous medication combinations
  • In cases of CRE with more severe symptoms, such as septic shock and rapidly progressing disease, a combination of antimicrobial agents is more effective than monotherapy
• Common drugs used to treat ECC
  • Beta-lactams
  • Beta-lactamase inhibitors
  • Aminoglycosides
  • Sulfamethoxazole or trimethoprim
  • Fluoroquinolones
  • Carbapenems
• Physical therapy
  • Recommended for people with Enterobacter infections because many are physically weak and bedridden

Intravenous antibiotics may be changed to oral antibiotics once the person has recovered in the inpatient setting, and treatment can then be completed as an outpatient regimen.

The mortality rate for Enterobacter cloacae complex (ECC) infections is generally high. Complications may include:

• Lung abscess
• Pleural effusion
• Acute respiratory distress syndrome
• Sepsis and septic shock

ECC bacteria cause nosocomial episodes mainly in immunocompromised individuals and can cause a wide spectrum of systemic diseases. Infection is often serious, and treatment complications are exacerbated by ECC strains' high level of antibiotic resistance.

Nosocomial infections are a major cause of morbidity and mortality in the United States. Every year, about 1 in 25 hospital admissions are found to have at least one infection because of difficulties with healthcare.

Despite their therapeutic significance, the virulence and pathogenicity of ECC are poorly understood.

Even with appropriate treatment, Enterobacter cloacae complex infections are dangerous infections with a high mortality rate. Prevention can help prevent serious symptoms and may lower death rates. Common preventive measures may include the following:

• Avoiding unnecessary use of medical devices for long periods of time
• Avoiding inappropriate use of antibiotics
• Strict infection control protocols (disinfection and sterilization in hospitals are now a focus of concern because these infections are most pervasive in such settings)