How Do You Get Enterobacter Cloacae Complex?

Medically Reviewed on 11/30/2022
How Do You Get Enterobacter Cloacae Complex
Enterobacter cloacae complex has been known to cause infections in intensive care units (ICUs)

Enterobacter cloacae complex (ECC) are naturally occurring bacteria that live in the digestive tract and has been known to cause infections in intensive care units (ICUs).

Potential causes of ECC bacteria may include:

  • Direct or indirect contact with infected people
  • Contaminated infusion solutions or blood products

Potential risk factors for ECC bacteria may include:

  • Recent hospitalization
  • Admission to ICU
  • Recent invasive procedure
  • Prolonged use of invasive medical equipment
  • Long-term antibiotic use
  • Immunocompromised state (diabetes and cancer)

Is Enterobacter cloacae complex common?

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.

What diseases are caused by Enterobacter cloacae?

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

What are the signs and symptoms of Enterobacter cloacae complex?

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

What are treatment options for Enterobacter cloacae complex?

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
  • 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.


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Is Enterobacter cloacae life-threatening?

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

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.

Can Enterobacter cloacae complex be prevented?

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)
Medically Reviewed on 11/30/2022
Image Source: iStock image

Enterobacter cloacae complex: clinical impact and emerging antibiotic resistance.

Enterobacter species.