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PubMed2001

[Enterobacter cloacae epidemic on a neonatal intensive care unit due to the use of contaminated thermometers].

From December 1999 to March 2000 a nosocomial outbreak of multiresistant Enterobacter cloacae occurred in the neonatal intensive care unit (NICU) at the VU Medical Center, Amsterdam, the Netherlands. Twenty-six patients were infected or colonized with this strain resistant to third generation cephalosporins and with decreased sensitivity for aminoglycosides. Three neonates experienced sepsis with E. cloacae with serious clinical symptoms and two of them died. Comparison of the Enterobacter isolates by amplified-fragment length polymorphism indicated that this outbreak was caused by the spread of a single strain. Infection control precautions were initiated in order to stop further spread; barrier precautions, enforcement of hand disinfection and cohorting of colonized patients. A multidisciplinary crisis team coordinated these infection control precautions and informed all persons involved. Analysis of antibiotic usage in 1999 showed an increase in the use of third generation cephalosporins from November onwards. Due to the resistance pattern of the epidemic strain the use of third generation cephalosporins was discontinued in February 2000. At the end of February the NICU was temporarily closed. The epidemic strain of E. cloacae was isolated from one digital rectal thermometer. Patient use of thermometers and disposable coverings for rectal thermometers were introduced to eliminate this possible means of spread. No spread of multiresistant E. cloacae was found following the introduction of these interventions. Once all the neonates had been transferred, the NICU was disinfected and reopened in March.

Cephalosporin Resistance↗
PubMed2001

Enterobacter sakazakii infection in the newborn.

UNLABELLED: Enterobacter sakazakii, a Gram-negative bacillus, previously known as "yellow pigmented Enterobacter cloacae", is a rare cause of neonatal infection. We describe the detailed clinical presentation of two cases in whom E. sakazakii was isolated in our neonatal service during the course of 1 mo. These include one case of sepsis and meningitis complicated by cerebral infarction, and one case of sepsis. In addition, three cases of intestinal colonization were identified. The source of the organism was thoroughly sought and was found to be a blender in the milk kitchen that was used for preparation of the reconstituted powdered milk formula. CONCLUSION: Our paper adds clinical and laboratory information about the disease spectrum caused by this relatively rare organism and emphasizes the importance of a thorough search for the source of the infection.

Central Nervous System Infections↗
PubMedDate not supplied

[Beta-lactam resistance in aquatic Enterobacter cloacae strains using phenotypic and genotypic criteria].

Bacterial resistance by producing of beta-lactamases represents an increasing problem of infections chemotherapy. beta-lactam hydrolyzing activities are detected in virtually all bacteria, from witch Enterobacter cloacae produce chromosomal beta-lactamases included in inducible class AmpC beta-lactamases. The purpose of this preliminary study was to investigate the antibiotic susceptibility of 7 inducible beta-lactamase-producing Enterobacter cloacae strains isolated from aquatic sources (river and polluted waters). The identification to the species level was performed with the API 32E system and susceptibility to antimicrobial agents was tested by the disk diffusion method according to NCCLS recommendations. The following antibiotics were tested: ampicillin, amoxycillin/clavulanic acid, ceftazidime, cefotaxime, cephalotin, cefamandole, cephaclor, imipenem, amikacin, gentamycin, kanamycin, tobramycin, ciprofloxacin, norfloxacin, ofloxacin, nalidixic acid, tetracycline and chloramphenicol. Minimum inhibitory concentrations (MICs) were performed using dilution method in Mueller-Hinton broth with a 0.06-64 micrograms/ml concentration range for all antimicrobials and bacterial inoculum of about 1-2 x 10(8) cfu/ml. For the data analysis NCCLS breakpoints for resistance and sensitivity were used. Interaction of beta-lactamase inhibitor clavulanate with cefotaxime was performed by double-disk synergy test. Detection of inducible beta-lactamase expression was performed by the inductibility disk diffusion test using cefotaxime, ceftazidime and imipenem. Genomic DNA was isolated using CTAB technique and bacterial plasmid isolation was performed by an alkaline lysis method. Genetic characterization was performed by agarose gel electrophoresis and spectrophotometric analysis. The majority of examined E. cloacae strains were sensitive to imipenem, cefamandole, amikacin and quinolones (norfloxacin and ofloxacin), a higher moderate resistance being observed only to nalidixic acid (higher than 50%) and ciprofloxacin (15%). The percentage of resistant strains ranged from 72% (to kanamycin) to 87% (to gentamicin). The best results (resistance about 99%) were obtained with ampicillin, amoxycillin/clavulanic acid, ceftazidime, cefotaxime, cephalotin, cephaclor, tobramycin, tetracycline and chloramphenicol. The disk diffusion tests showed the absence of extended-spectrum beta-lactamases production and the expression of inducible beta-lactamases. Electrophoretic patterns point out the presence of plasmid DNA. Plasmid profile revealed the presence of several different plasmids ranging from 2.5 kpb to more than 30 kpb. The presence of inducible beta-lactamase E. cloacae strains in aquatic media (river and polluted waters) and the closely related pattern of susceptibility among these strains reflect the possible contamination of these sources and the common origin of them.

Anti-Bacterial Agents↗
PubMed2006

Clinical characteristics and risk factors for attributable mortality in Enterobacter cloacae bacteremia.

BACKGROUND AND PURPOSE: Enterobacter spp. have emerged as an important cause of nosocomial bacteremia. The purpose of this study was to delineate the clinical, laboratory and microbiologic features that may influence prognosis of Enterobacter cloacae and enable a stratification of those patients at high risk of mortality. METHODS: This retrospective study reviewed 108 episodes of E. cloacae bacteremia occurring over a 2-year period (November 2001 to October 2003) at Taipei Veterans General Hospital. Univariate analysis were performed to demonstrate the relation of possible risk factors to death attributable to E. cloacae bacteremia. RESULTS: Ninety-three episodes (86.1%) were hospital-acquired. The most common portal of entry was the genitourinary tract (17.9%) followed by the gastrointestinal tract (15.1%). Underlying diseases associated with E. cloacae bacteremia were neoplastic diseases (42 episodes, 38.9%), diabetes mellitus (20 episodes, 18.5%) and chronic renal failure (18 episodes, 16.7%). The overall mortality rate was 42.6%, and E. cloacae bacteremia-attributable mortality occurred in 22 patients (20.9%). Factors significantly correlated with death attributable to bacteremia were older age, a higher medium number of underlying diseases, hemoglobin <10 g/dL, serum C-reactive protein >10 mg/dL, hypoalbuminemia, disseminated intravascular coagulation, septic shock, respiratory failure, renal failure (creatinine >2 mg/dL) and delayed clinical response after initiation of antibiotic therapy. CONCLUSIONS: Antibiotic-resistant isolates and appropriate empirical antibiotic use were not independent predictors of mortality in this study. The condition of patients at onset of symptoms and presence of underlying diseases appear to be important predictors mortality from E. cloacae bacteremia.

Adolescent↗
PubMed1991

Why are carbapenems active against Enterobacter cloacae resistant to third generation cephalosporins?

The broad antibacterial activity of carbapenems includes Gram-negative rods resistant to third generation cephalosporins. To increase the understanding of this improved activity, the factors involved in the efficacy of imipenem and ceftriaxone against Enterobacter cloacae have been examined. Resistance to ceftriaxone is primarily the result of a selection of resistant clones ("derepressed mutants"), pre-existing within the Enterobacter populations. Most of the resistant clones produce large amounts of beta-lactamases, and some of them show a decreased expression of porin F coupled with an increased expression of porin C. Determination of outer membrane permeability, as calculated in intact cells using a HPLC-based technique, showed that imipenem penetrated three times faster than ceftriaxone. Moreover, unlike ceftriaxone, imipenem penetration was not affected in a porin F deficient mutant. This suggests that imipenem has an additional pathway not available for ceftriaxone, possibly porin C. The rate of beta-lactamase hydrolysis in experimental conditions thought to be physiologically relevant, and the affinity for PBPs, estimated by calculation, were similar for the two antibiotics. Thus, the activity of imipenem against ceftriaxone resistant E. cloacae seems to result mainly from a selective permeability of the outer membrane.

Bacterial Outer Membrane Proteins↗
PubMed1988

[Experimental Enterobacter cloacae endocarditis treated with gentamicin. Predictive value of the in vitro bactericidal rate].

The predictive value of in vitro time-kill curve was tested on an Enterobacter cloacae endocarditis experimental model. The antibiotic studied was gentamicin. Despite a similar MIC, 2 Enterobacter cloacae strains exhibited very different time-kill curves in vitro. This difference was found being predictive of efficacy on the in vivo model, 24 hours after a single injection of gentamicin.

Animals↗
PubMed1978

Septic arthritis caused by Enterobacter agglomerans.

A case of septic arthritis was caused by Enterobacter agglomerans, an association that to our knowledge has not been described previously. The right knee joint of a previously healthy 11-year-old boy became infected when the organism was introduced through the overlying skin by a contaminated wooden splinter. Conservative management with antibiotic therapy and repeated arthrocenteses was successful. Enterobacter agglomerans is a known plant pathogen, and a relationship between human infections caused by this organism and contact with plants is well recognized. The patient described here demonstrates that, when given a suitable set of environmental circumstances, E agglomerans can cause infection in man, including septic arthritis.

Arthritis, Infectious↗
PubMed1978

R factors from Enterobacter group.

Twenty-six R factors transmissible to E. coli K12 were derived from 79 strains of Enterobacter species isolated in various clinical specimens (urine, sputum, blood, pus); 71 of 79 strains were Enterobacter cloacae. Fifteen R factors were fi+: 14 belonged to group FII, 1 to group FI. Eleven R factors were fi-: 5 belonged to group M, of the others 6 (all controlling the cloramphenicol-resistance) 1 was recognized of group K, 1 was incompatible with standard plasmids of both groups S and W, and 4 belonged to group S.

Anti-Bacterial Agents↗
PubMed1983

Differentiation of resistance determinants to cefamandole and cefoxitin in Enterobacter cloacae strains.

The mechanism of resistance to cefamandole and cefoxitin was investigated in Enterobacter cloacae with the aid of cefamandole-resistant variants and their derived beta-lactamase-deficient mutants. Cefamandole-resistant variants were easily obtained from clinical isolates by direct selection. Massive beta-lactamase production seemed to be the underlying resistance mechanism, although lack of penetrability may further substantiate this resistance. The mechanism of resistance to cefoxitin in parent, variant and mutant strains on the other hand was more complex, and probably due to a complex interrelation of parameters. Apart from relative instability to beta-lactamases and lack of penetrability, the high beta-lactamase-inducing power of cefoxitin is perhaps the most important determinant in the resistance of Enterobacter to this compound.

Cefamandole↗
PubMed1983

[Characteristics of Proteus, Klebsiella, Enterobacter and Citrobacter strains isolated in urological infections].

The comparative study of more than 300 Proteus, Klebsiella, Enterobacter and Citrobacter strains isolated from patients with urological infections and parenteral infections of other localization, as well as from the feces of healthy persons has been carried out. The strains causing inflammatory processes in the urinary tract have been shown to possess no strict specificity. The ability of opportunistic enterobacteria to cause urinary tract lesions is their polydeterminant property ensured by the combination of different factors. A number of characteristics which can be considered as the markers of "nephritogenic" strains have been revealed. Thus, among Proteus mirabilis strains the largest percentage is constituted by strains fermenting sucrose and producing hemolysin. The urological pathogenicity of "nephritogenic" strains belonging to the genera Proteus, Klebsiella and Enterobacter has been found to be linked with their resistance to complement and their capacity for producing substances increasing capillary permeability. In C. freundii strains differences in O serogroups and a number of markers (the fermentation of raffinose, the formation of hemolysin and permeability factor) have been revealed. These data may be useful for the prognosis and evaluation of the course of urological infections.

Animals↗
PubMed1981

[Bacteriocin typing of Enterobacter cloacae strains (author's transl)].

By means of bacteriocin typing epidemic studies were carried out with regard to 65 strains of Enterobacter cloacae, isolated from various specimens of 59 patients. Based on detailed preliminary investigations the presentation with bacteriocins in liquid cultures induced by Mitomycin C was found most preferable. Since constant and reproducible results are essential, standardization of culture media, incubation temperature, incubation time and inoculum size is required. By means of 13 bacteriocin-producing strains the isolates could be typed and categorized into 24 types according to their sensitivity to bacteriocins. A rather varied picture emanated from the distribution of the individual types with regard to the different medical fields so that cross-infection with a certain strain was negligible. Seeing that one bacteriocin type was found predominantly in the intensive care unit, it can be maintained that this strain originated from the ward itself. The importance of bacteriocin typing for the interpretation of certain up-to-date epidemic situations is obvious which typing has also been successfully employed with regard to investigations of Enterobacter cloacae infections. However, it is doubtful whether bacteriocin production and bacteriocin sensitivity sufficiently constant in order to obtain comparable results over a more extended period of time and in different areas.

Bacteriocins↗
PubMed1982

[Heterogeneity of the fatty acid composition of bacteria in the genera Klebsiella, Enterobacter, Hafnia and Serratia].

The analysis of the chromatograms of methyl esters of fatty acids in bacterial strains of the tribe Klebsielleae showed the heterogeneity of the fatty acid composition of bacteria belonging to the genera Klebsiella, Enterobacter, Hafnia and Serratia. The bacteria of this tribe could be subdivided into 5 provisory groups in accordance with the composition and profile of their fatty acids. Group I comprised K. pneumoniae K1, K. ozaenae and K. rhinoscleromatis strains forming a separate group characterized by the absence of cyclopropane fatty acids; group II comprised K. pneumoniae strains of other capsular serovars (K2, K8, K11, K13, K41, K47), as well as K. aerogenes and K. oxytoca strains. The fatty acid composition of the strains of group III, comprising E. aerogenes and E. cloacae, was similar to that of E. coli O1; only among the fatty acids of these bacteria acid C20:0 could be detected. H. alvei strains were included into group IV; their fatty acid profiles were similar to those of the genus Enterobacter, but had a higher content of acids C15:0 and C18:0. S. marcescens strains were similar to the strains of group II in their fatty acid composition, but considerably differed from the latter by a higher content of hexadecanoate (C16:0) and a lower level of C18:1; for this reason they were regarded as provisory group V.

Chromatography, Gas↗
PubMed1981

Klebsiella and Enterobacter strains derived from hospital infections. II. Occurrence and characterization of R-, Lac- and Col- plasmids and their clinical-epidemiological significance.

A total of 269 hospital Klebsiella strains and 103 hospital Enterobacter strains showed 34 and 10 different antibiotic resistance patterns, respectively. Among multiple resistant Klebsiella and Enterobacter strains the Ap Sm Cm Tc resistance pattern was the most frequent (K. aerogenes). Antibiotic resistant strains carried R-plasmids in 27.5%. The presence of R-plasmids was demonstrable in 2.9% of single antibiotic resistant, in 12.8% of double antibiotic resistant, and in 71.4% of multiple antibiotic resistant Klebsiella strains. R-plasmid carriage was most frequent in strains of the species K. pneumoniae and K. atlantae. Transfer frequency of R-plasmids of multiple resistant strains was generally higher into Escherichia coli K12 recipient (10-1 to 10-2) than into K. pneumoniae recipient (10-3 to 10-5). Regarding the individual resistance determinants, transfer frequency of Km-Nm resistance was the highest (65.1%). The lac-plasmid was demonstrable in 18 out of the 77 R-plasmid carrying Klebsiella strains. R- and Lac-plasmids of single and multiple resistant Klebsiella strains could be transferred into E. coli and Klebsiella recipients in mice in vivo. As many as 67% showed fi- and 33% showed fi+ character among the demonstrated 112 R-plasmids. Regarding their incompatibility, the studied five plasmids belonged to groups FI, FII and I alpha. Altogether 14 different groups could be distinguished among R-plasmids on the basis of their phage restriction capability on phage lambda and coliphages T, and another group of R-plasmids showing no restriction at all. Fi+ character was demonstrated in 54.5% of R-plasmids showing phage restriction capability and in 10.9% of R-plasmids showing no phage restriction. Nearly twice as many R-plasmids carrier strains were found among non-typable ones as among those typable by phages. Three R-plasmids showed phage-modification among 51 R-plasmids restrictive for phages. In addition to the phage-type of Klebsiella strains, R-plasmids can also be used as an epidemiologic marker.

Bacteriocin Plasmids↗
PubMed1995

[Resistance to imipenem in Enterobacter aerogenes].

BACKGROUND: In June, 1993, an Enterobacter aerogenes strain was isolated in the Hospital de la Creu Roja from Hospitalet de Llobregat (Barcelona), which was resistant against all beta-lactams, including imipenem. Since is unusual in Enterobacter sp. to isolate imipenem resistant strains, we decided to study its resistance mechanism. METHODS: To study the E. aerogenes 174004/H resistance mechanism beta-lactamase isoelectrofocalization was performed together with the determination of kinetic constants in order to characterize the beta-lactamase, and a polyacrylamide gel electrophoresis in order to observe the profile. RESULTS: The strain of E. aerogenes 174004/H exhibits a chromosomic beta-lactamase with a pI higher than 9.2 and a decrease in an outer membrane protein of 42 kDa, probably a porine. CONCLUSIONS: E. aerogenes 174004/H resistance against imipenem is due to an hyperproduction of a chromosomic beta-lactamase with a pI higher than 9.2 and to a 42 kDa decrease of an outer membrane protein expression.

Bacterial Outer Membrane Proteins↗
PubMed1994

[Fingerprinting with the polymerase chain reaction: confirmation of a Enterobacter cloacae epidemic in a neonatal intensive care unit].

Between end December 1993 and end January 1994 a cluster of children infected/colonized with Enterobacter cloacae was seen in the neonatal intensive care unit of the University Hospital Nijmegen. The results of the epidemiological investigation are reported, which was aimed to differentiate between a random cluster of endogenously acquired Enterobacter strains and those possibly acquired exogenously via cross-infection. 5 isolates of the 7 patients were available for fingerprinting using interrepeat PCR. According to the fingerprint pattern, 4 of these isolates were identical, thereby suggesting cross-infection among the children. 3 neonates were colonized/infected with genotypically different isolates, suggesting that the infection/colonization developed endogenously. A control strain isolated from a patient at another ward showed the same genotype as the outbreak isolates. The transmission took probably place through one of the surgeons who, among all possible health care workers, were the only professional group treating patients in both units.

Cross Infection↗
PubMed1993

Enterobacter agglomerans--associated cotton fever.

Cotton fever is usually a benign febrile, leukocytic syndrome of unknown etiology seen in intravenous narcotic abusers. Cotton and cotton plants are heavily colonized with Enterobacter agglomerans. We report a case of cotton fever associated with E agglomerans in which the organism was first isolated from the patient's blood and secondarily from cotton that he had used to filter heroin. Enterobacter agglomerans is with most probability the causal agent of cotton fever. Patients presenting with the classic history should have blood cultures performed and should be started on a regimen of empiric antibiotic therapy.

Adult↗
PubMed1996

[Variation in transfer resistance to cefotaxime, ceftazidime and aztreonam in strains of Acinetobacter sp., Enterobacter sp. and Citrobacter sp. isolated from the same university hospitals].

BACKGROUND: In the last decade were in SR documented new problems in resistance to the newer antibiotics that with regard to their structure and antibacterial properties resisted to the known mechanism of bacterial resistance. The emergence of multiple drug resistance to the new betalactams is connected both with frequent application of these drugs in the hospitals and transfer of R plasmids. METHODS AND RESULTS: We studied composition and transferability of resistance to newer betalactam antibiotics in strains of Acinetobacter sp., Enterobacter sp, and Citrobacter sp. isolated during one month in patients from two teaching University Hospitals. All strains studied were resistant to cefotaxime (CTX), ceftazidime (CAZ) and aztreonam (ATM) but Acinetobacter strains, although resistant also to CAZ and ATM transferred the resistance to CTX only. Thus, resistance to CAZ and ATM has a chromosomal origin in these strains. A strain of Citrobacter sp., resistant to CTX, CAZ and ATM, produced a ESBL betalactamase detectable in a double-disk diffusion method (Fig. 1). An Enterobacter cloacae strain transfers directly the resistance to all new betalactams indicated. Their hydrolysis by these strains points to their production of new types of extended-spectrum beta-lactamases ESBL). CONCLUSIONS: We strongly recommend to be strictly rational in the use of new betalactams of CTX, CZA or ATM type because it is suspected that, especially in so-called empirical prophylaxis or treatment, they exert a strong selective pressure toward the prevalence of mutants with transferable ESBL-producing nosocomial bacteria resistant to these drugs.

Acinetobacter↗
PubMed1996

[Kinetics of bactericidal activity of cefepime and cefpirome alone or combined with gentamicin, amikacin or ciprofloxacin against Acinetobacter baumannii, Stenotrophomonas maltophilia and Enterobacter cloacae hyperproductive in cephalosporinase].

Nosocomial infections encountered in intensive care units are frequently due to Gram negative bacilli among which Stenotrophomonas maltophilia, Acinetobacter sp., and Enterobacter sp. The aim of the present study was to evaluate the in vitro bactericidal activity of the new broad spectrum cephalosporins cefepime (FEP) and cefpirome (CPO) alone or in combination with amikacin (AKN), gentamicin (GTN) or ciprofloxacin (CIP) against Acinetobacter baumannii, Stenotrophomonas maltophilia and Enterobacter cloacae producing a derepressed cephalosporinase. This study was performed by using the time-kill curve method on 24 h with a starting inoculum of 10(6) - 10(7) cfu/ml. The combination of FEP (4 mg/l) with AKN (4 mg/l) against A. baumanii only results in about 1 log decrease at 24 h, but when FEP is combined at 8 mg/l, the decrease reaches 4 log in 24 h. The combination of FEP (16 and 32 mg/l) clavulanic acid (4 mg/l) resulted in 3 log decrease at 24 h. When combined with CIP 2 mg/l, FEP (16 and 32 mg) resulted in 5 and 6 log decrease in 24 h respectively. There were no survival bacteria at 6 h when FEP (32 mg/l) was combined with clavulanic acid (4 mg/l) and GTN (8 mg/l) at 6 h. Used alone FEP (1 mg/l) or CPO (1 mg/l) against E. cloacae, a 3 log decrease occurs at 6 h followed by a regrowth at 24 h. Combined with AKN (2 mg/l), FEP (1 mg/l) results in a 6 log decrease at 24 h, when CPO at 2 mg/l is needed for an equivalent result. These data show synergistic bactericidal activity of both new extended cephalosporins combined with AKN, GTN or CIP at concentrations achievable in biological fluid with adaptative dosage regimen.

Acinetobacter↗