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PubMed1997

[The clinical manifestation and drug sensitive tests of lower respiratory tract infection by enterobacter cloacae. The Pulmonary Infection and Fibrosis Group, Thoracic Society Shanghai Medical Association].

OBJECTIVE: To study the clinical characteristics of lowar respiratory tract infection caused by E. cloacae and to investigate the drug sensitivities of E. cloacae strains. METHOD: (1) Analysing the clinical deta of 58 case with lowa respiratory tract infection of enterobacter cloacae defined by a putative standard, including ages, symptoms, signs, underlying diseases, sputum culture, X-ray findings and the prognosis. (2) Determining the drug sensitivities against the E. cloacae strains by K-B method. RESULTS: (1) There were 46 males and 12 females, with the mean age 56 +/- 19% cases diagnosed, who had underlying diseases, most were COPD. 41% cases were mixed infections with other bacteria, most of which were P. aeruginosa and K. pneumoniae. The chief symptoms were fever (72%) and productive cough (87%). The chest X-ray revealed inflammatory infiltration in lower lobes of both sides. The mortality rate was 9%. (2) The antimicrobial tests in vitro showed that these strains were multiresistant to antibiotics, but imipenem, amikacin, tobramycin, ciprofloxacin, cefoaperazone were sensitive. CONCLUSIONS: The lower respiratory tract infections caused by E. cloacae showed no specific clinical manifestations. However, the mortality was high. The diagnosis should be made according to bacteriologic examination combined with clinical and X-ray manifestations. Combining antibiotics therapy was recommanded according to antimicrobial sensitivity test.

Adult↗
PubMedDate not supplied

Analysis of semen quality from each testis/duct system of a turkey with a duplicated cloaca and vent.

A case is described wherein a turkey male (tom) possessed two vent areas with duplicated cloacae served by one large intestine. Both cloacae were functional in that feces were excreted and semen could be collected from each. The left vas deferens and ureter emptied into the left cloaca, and the right vas deferens and ureter emptied into the right cloaca. This allowed semen from each testis/duct to be collected separately from the corresponding cloaca. Thus, a unique opportunity was presented to collect semen separately from the left and right testis/duct system for semen analysis and fertility determination. Sperm concentration and percentage of dead sperm were not significantly different when semen from left vs. right reproductive tract were compared. The concentrations of spermiophages in semen from both reproductive tracts fell into the range reported for normal semen (0-8 x 10(5)/ml); however, semen from the right side had consistently higher spermiophage concentrations than that from the left side. On the basis of observations from one male made possible by an anatomic anomaly, it appears that the fecundities of the left and right testis/duct systems of the turkey male do not significantly differ and that recruitment of spermiophages into one tract (because of immunologic challenge, etc.) does not necessarily mean that the opposite testis/ducts will respond similarly.

Animals↗
PubMed2001

[The inducibility of Amp C enzyme of Enterobacter cloacae and its susceptibility to enzyme inhibitor].

OBJECTIVE: To study the inducibility of Amp C enzyme of Enterobacrter cloacae and its susceptibility to enzyme inhibitor. METHODS: The in vitro activities of the fourth generation cephalosporins-cefepime, the third generation cephalosporins-cefuroxime, cefotaxime, ceftazidime combined with beta-lactamase inhibitor sulbactam against 10 strains of ceftazidime resistant Enterobacter cloacae selected from the hospitals was studied with agar two fold dilution method. The inducibility of beta-lactam antibiotics in common use clinically to Amp C enzyme and the inhibitory action of 3 inhibitors to Amp C enzyme were studied with ultraviolet spectrophotometry and RTPCR. RESULTS: Sulbactam can not enhance the activity of ceftazidime against Enterobacter cloacae. Cefepime has a strong activity against ceftazidime resistant Enterobacter cloacae. Imipenem has a strong inductive action to Amp C enzyme. Ro481220 has a strong inhibitory action to Amp C enzyme. CONCLUSION: Infections caused by Enterobacter cloacae producing Amp C enzyme can be treated by cefepime.

Bacterial Proteins↗
PubMed1975

[Development of the cloaca and its ulterior transformations in the polypterids (Pisces)].

Generally spoken cloacae have been but little studied. In Polypterus, a brachiopterygian fish, a cloaca only exists during parts of the embryonal and larval life and it gets replaced by structures consisting of an anus and an urinary sinus. In the beginning of embryonal life the posterior opening of the body seems to be nothing else than the original blastoporus. The wall of this opening acquires evaginations; the anlagen of the excretory ducts come in contact with them, establishing in that way a structure, that merits the name of cloaca. During the elongation of the post-vitellin body, the latter gets shifted from the level of metamere XII to that of metamere XXX. Another migration of the cloaca occurs when the digestive system acquires its development. Finally the cloaca may be found under the 47th and 48th muscular segments (at least in the species Polypterus senegalus senegalus Cuvier). During these stages the excretory ducts have build up an urinary sinus that gets separated from the gut. In adults no communication exists any more between the gut and the urinary sinus; the latter is a very destinct organ that may have an impair or pair aspect according to its being filled up. Because of the establishing of a communication with the genital ducts the sinus becomes an uro-genital sinus in the adult.

Animals↗
PubMed2002

[The expression of AmpC and extended-spectrum beta-lactamases among clinical isolates of enterobacter cloacae and its impact on antibiotics susceptibility].

OBJECTIVE: To investigate the expression of AmpC beta-lactamases and ESBL among clinical isolates of E. cloacae and its impact on antibiotic susceptibility. METHODS: Antibiotic susceptibility was determined by standard agar dilution procedures. beta-lactamases of the isolates with decreased susceptibilities to ceftazidime, cefotaxime, ceftriaxon or aztreonam were investigated by three-dimensional extract tests, isoelectric focusing overlay technique, conjugation experiments and PCR. RESULTS: Among 106 E. cloacae isolates, 16.0% produced only high-level AmpC beta-lactamases, 10.4% produced only ESBL, 13.2% produced both high-level AmpC beta-lactamases and ESBL. 18 isolates (17.0%) carried CTX-M-type ESBL and 7 isolates (6.6%) carried SHV-type ESBL. All carbapenems showed high activity against E. cloacae strains (MIC90 <or= 2 micro g/ml). More than 70% of the isolates producing only high-level AmpC beta-lactamases were susceptible to cefepime, amikacin, gentamicin or ciprofloxacin. More than 60% of the isolates producing only ESBL were susceptible to piperacillin/tazobactam, cefoperazone/sulbactam, ciprofloxacin or amikacin. The susceptible rates of the isolates producing both high-level AmpC beta-lactamases and ESBL to tested antimicrobial agents other than carbapenems were all lower than 25%. CONCLUSION: CTX-M-type ESBL was prevalent among clinical isolates of E. cloacae. Resistance to expanded-spectrum cephalosporins in E. cloacae was mediated not only by AmpC beta-lactamases but also by ESBL. Expression of ESBL in high-level AmpC beta-lactamases producing strains resulted in a significant rise in resistance level.

Anti-Bacterial Agents↗
PubMed1989

Isolation and Characterization of an Enterobacter cloacae Strain That Reduces Hexavalent Chromium under Anaerobic Conditions.

An Enterobacter cloacae strain (HO1) capable of reducing hexavalent chromium (chromate) was isolated from activated sludge. This bacterium was resistant to chromate under both aerobic and anaerobic conditions. Only the anaerobic culture of the E. cloacae isolate showed chromate reduction. In the anaerobic culture, yellow turned white with chromate and the turbidity increased as the reduction proceeded, suggesting that insoluble chromium hydroxide was formed. E. cloacae is likely to utilize toxic chromate as an electron acceptor anaerobically because (i) the anaerobic growth of E. cloacae HO1 accompanied the decrease of toxic chromate in culture medium, (ii) the chromate-reducing activity was rapidly inhibited by oxygen, and (iii) the reduction occurred more rapidly in glycerol- or acetate-grown cells than in glucose-grown cells. The chromate reduction in E. cloacae HO1 was observed at pH 6.0 to 8.5 (optimum pH, 7.0) and at 10 to 40 degrees C (optimum, 30 degrees C).

Journal Article↗
PubMed1977

Host-dependent, thermosensitive replication of an R plasmid, pJY5, isolated from Enterobacter cloacae.

The thermosensitive replication of an R plasmid, pJY5, isolated from Enterobacter cloacae, was studied. pJY5 consisted of 61 million daltons of covalently closed circular (CCC) deoxyribonucleic acid (DNA) with a buoyant density of 1.714 g/cm3 (55 mol % guanine plus cytosine). In Escherichia coli, this plasmid replicated stringently at 32 degrees C, but ceased its CCC DNA replication after a short incubation at 42 degrees C, resulting in production of R- segregants. The thermosensitive replication of pJY5 was not overcome by the coexistence of non-thermosensitive R plasmids. The plasmid manifested an inhibitory effect on host bacterial cell growth at 42 degrees C, although the effect was less prominent than that of R plasmids belonging to the T-incompatibility group, Rts1, R401, and R402. When the pJY5 plasmid was transferred into E. cloacae, however, no R- segregants were detected at any culture temperature, even 42 degrees C. Alkaline sucrose gradient analysis revealed that a significant amount of pJY5 CCC DNA was synthesized in E. cloacae at the high temperature but not in E. coli. Furthermore, the growth-inhibitory effect of pJY5 on hosts at 42 degrees C was not observed in E. cloacae. On the other hand, Rts1 and R401 were found to be thermosensitive in E. cloacae as well as in E. coli.

DNA, Bacterial↗
PubMed1990

[Enterobacter cloacae infections at the Regional Hospital in Tromsø].

Enterobacter cloacae was isolated from 69 patients hospitalized at the University Hospital of Tromsø, Norway, during a period of 18 months. The total lethality was 11.6% (8/69) and death occurred most often in patients with a serious underlying condition. Death due to septicaemia occurred in 4/10 patients. Multiple beta-lactam resistant strains were present in 15 patients and were associated with septicaemiae (7/10, p less than 0.0005). Cephalosporin treatment had been given to every third patient (24/69), and nearly half of them (10/24) were infected by multiple beta-lactam resistant E cloacae. E cloacae occurred mainly as a nosocomial infection, since more than 70% of all patients infected had been treated by an invasive procedure prior to isolation of the bacterium. A high number of E cloacae strains were from operation wounds, especially among patients at the Department of Surgery (22/30). At this Department, the total number of E cloacae, and especially the number of multiresistant strains, was markedly reduced during restricted use of cefalosporins.

Adolescent↗
PubMed1997

Vertebral column and spinal cord malformation in children with exstrophy of the cloaca, with emphasis on their functional correlates.

Exstrophy of the cloaca is a dramatic malformation whose embryology is poorly understood. While the management of this disorder has received significant attention in the urology and general surgery literature, the neurologic status of these children has been poorly addressed. In order to better characterize the spinal cord and vertebral column malformations found in children with exstrophy of the cloaca, we undertook a clinical review of 26 consecutive children with exstrophy of the cloaca who had been seen at a single institution over 28 years. The prevalence of vertebral malformations in the 25 children who could be evaluated was 25/25 (100%). Twenty (80%) of the children had at least one vertebral fusion, most frequently at T-7. Twenty-two (88%) of the children had at least one vertebra with deficient posterior elements, and the spinal levels most frequently involved were S-2, S-3, S-4 and S-5. Nine (36%) of the children had at least one vertebra with a narrowed interpedicular distance, most frequently at T-7. Nine (36%) of the children had at least one vertebra with atrophic facet anatomy, most frequently at L-3. The prevalence of myelodysplasia in the 19 children for whom spinal magnetic resonance imaging or intraoperative findings were available was 100%. Of these 19 children, 15 (79%) had myelocystocele, 2 (11%) had a lipomeningocele, 2 (11%) had a meningocele, 2 (11%) had hydromyelia, and 4 (21%) had a tethered cord. These data suggest that spinal cord and vertebral column malformations are very common in children with exstrophy of the cloaca.

Abnormalities, Multiple↗
PubMed1993

Enterobacter cloacae cross-colonization in neonates demonstrated by ribotyping.

The intestinal colonization by Enterobacter cloacae strains with a derepressed cephalosporinase was studied in a paediatric ward between February 1990 and January 1991. Environmental sampling was performed simultaneously. Fifty-two isolates were recovered from 200 neonates (stool, blood) and 14 strains were isolated from the neonatal environment. An epidemiological study based on the typing of 36 Enterobacter cloacae isolates was carried out using antibiotyping, biotyping and ribotyping methods. The isolates selected were from 21 neonates (24 isolates), the neonatal ward environment (8 isolates) and from other wards (4 isolates). Thirty-two isolates had the same antibiotic resistance pattern, corresponding to a derepressed cephalosporinase and resistance to the following aminoglycosides: kanamycin, gentamicin, tobramycin and netilmicin. No predominant biotyping pattern could be established. Ribotyping done with two endonucleases (EcoRI and BamHI) showed 28 Enterobacter cloacae isolates to have a single pattern. Ribotyping was the most discriminating method used in this study, permitting identification of cross-contamination with Enterobacter cloacae in the paediatric ward.

Bacteremia↗
PubMed2001

Further studies on RpoS in enterobacteria: identification of rpoS in Enterobacter cloacae and Kluyvera cryocrescens.

RpoS, the alternative sigma factor sigma(s), is important for bacterial survival under extreme conditions. Many enterobacteria are opportunistic human pathogens and their ability to survive in a changing environment could be an essential step for their virulence. To determine the presence of this gene in enteric bacteria, an Escherichia coli rpoS probe was constructed and used to detect the presence of this gene in different species. A gene homologous to rpoS was found in Citrobacter amalonaticus, Enterobacter cloacae, Klebsiella planticola, Kluyvera cryocrescens, Serratia rubidaea, Shigella sonnei, and Yersinia ruckeri. Providencia stuartii and Proteus vulgaris were the only tested enterobacteria that did not show any signal with the E. coli rpoS probe or that did not lead to amplification of an rpoS fragment using specific primers. The rpoS gene from E. cloacae and from K. cryocrescens was cloned and sequenced and a mutant allele was constructed in E. cloacae. Survival rates under different harsh conditions were followed in order to determine the effect of rpoS inactivation in exponential- and stationary-phase cells of both strains. E. cloacae rpoS mutants were more sensitive to extreme pH, high osmolarity, and high temperature than the wild-type.

Amino Acid Sequence↗
PubMed2005

Pitfalls in the management of newborn cloacas.

Clinicians caring for newborns with persistent cloaca face significant challenges in the newborn period. Avoiding key pitfalls during this time can have dramatic implications. We reviewed the medical records of 361 patients with cloaca operated on at our institution and analyzed sequelae that resulted from incorrect management in the newborn period. Of 361 patients, 282 underwent primary operations at our institution, and 79 patients were referred to us after a failed repair at other institutions. Pitfalls in management during the newborn period included the following: (1) Failure to recognize and manage hydrocolpos, which occurred in 46 patients. Of these, three patients developed pyocolpos (two progressed to vaginal perforation), and 43 suffered from persistent bilateral hydronephrosis, megaureters, recurrent urinary tract infections, persistent acidosis, or failure to thrive due to undrained hydrocolpos. They underwent unnecessary urinary drainage procedures (nephrostomy, ureterostomy, cystostomy, or vesicostomy) in the newborn period. When the vagina was finally decompressed, all of these symptoms disappeared. (2) Colostomy or vesicostomy problems, which occurred in 50 patients. These included incorrect placement of the colostomy (too distal, which interfered with the pull-through) in 24 and colostomy prolapse in 23. Incompletely diverting loop colostomies led to urinary tract infections in 49 patients. Vesicostomy prolapse occurred in three patients. (3) Clinical misdiagnosis, which occurred in 42 patients. Six were incorrectly diagnosed as "intersex" and 36 as "rectovaginal fistula." In this group only the rectum was repaired, and the patients were left with a urogenital sinus that required reoperation. Proper management of a newborn with cloaca includes drainage of a hydrocolpos, which avoids unnecessary urinary diversions and pyocolpos. Our preferred colostomy is one with separated stomas, adequate distal bowel for the pull-through, and use of a proper technique to avoid prolapse. Correct clinical diagnosis of cloaca avoids problems during the definitive repair.

Cloaca↗
PubMed2005

Single-stage operation without temporary colostomy for persistent cloaca with a short common channel.

Colorectal decompression with a catheter was performed for evacuation of stool before definitive surgery in two patients with a persistent cloaca. Two newborn female infants with persistent cloaca received placement of a silicone balloon-tipped catheter in the rectum via the cloacal orifice under fluoroscopic guidance at the time of diagnosis. The length of the cloaca was 2 and 1.5 cm, respectively. The diameter of the catheter was matched to the patients' rectal size and the open end was wrapped in a diaper to allow continuous drainage of stool. The infants underwent bowel irrigation with warm saline thrice a day, at home. Total urogenital mobilization was carried out in the infants at the age of 7 and 8 months, respectively. Both infants had no abdominal distension, colorectal dilatation, or urinary tract infection while the catheter was in situ. The postoperative course was uneventful, except for minimal wound dehiscence in one patient. At present, both infants can void spontaneously without any urological problems. In infants with a persistent cloaca less than 3 cm long and normal urinary tract function, adequate evacuation of stool may be achieved by colorectal decompression with a catheter, thus avoiding the need for a colostomy.

Cloaca↗
PubMed1989

Location of motoneurons innervating the musculus sphincter cloacae in the domestic fowl.

Horseradish peroxidase was injected into the musculus (m.) sphincter cloacae through the mucosa from the lumen side of the cloaca in the domestic fowl. Labeled neurons were found in the ventrolateral area of the ventral horn from the lumbosacral segments 7-9. The craniocaudal distribution of labeled neurons overlapped with that of hindlimb motoneurons. The m. sphincter cloacae is innervated by motoneurons sending axons to the sphincter cloacae either through the connexus caudalis branching from the caudal coxal nerve of the sacral plexus or through the lateral caudal nerve arising from the pudendal plexus.

Animals↗
PubMed2004

Emergence of Enterobacter cloacae as a common pathogen in neonatal units: pulsed-field gel electrophoresis analysis.

In the first week of December 2002, three infants hospitalized in the neonatal department of our hospital had blood cultures positive with Enterobacter cloacae. Screening cultures and genotyping showed that 10 of 25 screened patients also carried E. cloacae and that nine isolates belonged to the same clone as that responsible for all three bacteraemias. This epidemic cluster was limited to one of the two units of the department. Surveillance of both units continued until the end of March 2003; 51 of 159 neonates screened were colonized with E. cloacae, 38 out of 80 (47.5%) in the premature unit (PU) and 13 out of 79 (16.4%) in the paediatric intensive care unit (PICU). Pulsed-field gel electrophoresis (PFGE) analysis of 130 available isolates revealed 30 different pulsotypes, including 24 unique pulsotypes from individual patients and six from multiple patients. Antibiotic (particularly beta-lactam) use did not significantly vary from 1999 to 2003. The consumption of alcohol-based hand rub (four-fold higher in the PICU than in the PU) and nurse-to-patient ratio (1:2 in the PICU and 1:4 in the PU) might explain the higher cross-transmission rate in the PU. Finally, despite an epidemiological survey, we failed to identify the causes of the emergence of E. cloacae in our neonatology units. However, improved hygiene practices combined with restriction of admission led to the progressive disappearance of the epidemic strain. The increasing importance of this type of unit and the dramatic consequences of infections emphasize the need for additional research on the constitution of the flora of newborns and the mode of acquisition Gram-negative multi-resistant bacteria.

Anti-Bacterial Agents↗
PubMed2004

Nosocomial and community-acquired Enterobacter cloacae bloodstream infection: risk factors for and prevalence of SHV-12 in multiresistant isolates in a medical centre.

In a medical centre in northern Taiwan, 60 patients had bloodstream infection caused by Enterobacter cloacae from 1 January 2002 to 30 April 2003. Forty (66.7%) were nosocomial and 26 were caused by multiresistant isolates. Twenty patients died due to the infection. Central venous catheterization and mechanical ventilation were relative risks for nosocomial E. cloacae infection. Age and mechanical ventilation were risk factors for multiresistant E. cloacae infection. Mortality was associated with multiresistant isolates and polymicrobial infection. Pulsed-field gel electrophoresis (PFGE) analysis showed, the 26 multiresistant isolates comprised 12 different types, with type A predominating (12 isolates). Excluding the patients infected with PFGE type A, central venous catheterization was a relative risk for infection, and polymicrobial infection was a risk factor for mortality. All but one of the 26 multiresistant isolates had the extended-spectrum beta-lactamase SHV-12. TEM-1 and ampC beta-lactamase genes were also detected in 25 of the 26 multiresistant isolates. Southern blotting indicated that the SHV-12 gene was located on plasmids. Eleven of the 26 multiresistant isolates had minimum inhibitory concentrations (MIC) > or =16 mg/L for cefepime, which was reduced by the addition of sulbactam for most isolates, resulting in susceptibility. The combination of cefepime and sulbactam may be effective in the treatment of multiresistant E. cloacae bloodstream infection.

Adolescent↗
PubMed2026

Persistent cloaca without vaginal-common channel fistula: A Case series characterizing a rare phenotype.

INTRODUCTION: Persistent cloaca occurs in approximately 1 in 25,000 live births. Among patients with cloaca, the absence of a vaginal connection to the common channel represents a rare phenotype with distinct anatomic and management considerations. We describe the urologic, gynecologic, and surgical characteristics of this patient subset. METHODS: We performed a retrospective analysis of a single-institution cohort of patients with persistent cloaca managed at a quaternary-care children's hospital between 2019 and 2025. Patients were eligible if they underwent primary cloacal repair by our multidisciplinary team and met all three diagnostic criteria for absent vaginal-common channel fistula: no hydrocolpos on imaging, no identified vaginal opening on cystoscopy or cloacagram, and no visible lumen between m&#xfc;llerian and cloacal structures identified intraoperatively. RESULTS: Of 51 patients who underwent primary repair, 6 (12%) met criteria for absent vaginal-common channel fistula. All met criteria for VACTEGRLS association. Common channel length ranged from 1.1 to 7.0 cm and urethral length from 0.5 to 2.2 cm. Urologic anomalies were nearly universal: five patients (83%) had a solitary functional kidney and four (67%) had vesicoureteral reflux. All underwent posterior sagittal anorectoplasty (PSARP) for rectal repair with the common channel repurposed as the neourethra. Five (83%) underwent diagnostic laparoscopy during which the m&#xfc;llerian structures were examined but left in situ. At last follow-up (median 17.5 months, range 4-35 months), three patients (50%) had volitional voiding and three (50%) required assisted bladder emptying via vesicostomy or Mitrofanoff. CONCLUSION: Persistent cloaca without a vaginal-common channel fistula represents a rare but clinically distinct phenotype characterized by severe urologic anomalies. Recognition of this phenotype is essential for surgical planning and long-term urologic and gynecologic surveillance. Because there was no connection between the vagina and the urinary tract, delaying management of the m&#xfc;llerian structures did not adversely affect the urinary tract.

Humans↗
PubMed2001

Natural antibiotic susceptibility of strains of the Enterobacter cloacae complex.

The natural susceptibility to 70 antibiotics of 104 strains of the Enterobacter cloacae complex was examined using a microdilution procedure in Isosensitest broth. One hundred and one clinical strains designated as 'E. cloacae' were identified as E. hormaechei (n=65), E. asburiae (n=20) and E. cloacae genospecies 1 or 2 (n=16). Apart from fosfomycin susceptibility, there were only minor differences in natural antibiotic susceptibility patterns. All species were naturally sensitive or naturally sensitive and intermediate to numerous beta-lactams (e.g. carbapenems, aztreonam, acylaminopenicillins, ticarcillin, and some 'modern' cephalosporins), quinolones, aminoglycosides, tetracyclines, antifolates, chloramphenicol, and nitrofurantoin. Uniform natural resistance was found in benzylpenicillin, oxacillin, amoxycillin, amoxycillin/clavulanate, cefoxitin, rifampicin, lincosamides, glycopeptides, streptogramins and fusidic acid. Enterobacter hormaechei was the species most susceptible to fosfomycin. beta-Lactam susceptibility patterns pointed to the presence of chromosomally-encoded AmpC enzymes in all taxa of the E. cloacae complex.

Anti-Bacterial Agents↗