What are the initial steps in the management of Enterobacter infections?

Updated: Jun 18, 2019
  • Author: Susan L Fraser, MD; Chief Editor: Michael Stuart Bronze, MD  more...
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Answer

These "ICU bugs" cause significant morbidity and mortality, and infection management is complicated by resistance to multiple antibiotics. Enterobacter species possess inducible beta-lactamases, which are undetectable in vitro but are responsible for resistance during treatment. Physicians treating patients with Enterobacter infections are advised to avoid certain antibiotics, particularly third-generation cephalosporins, because resistant mutants can quickly appear. The crucial first step is appropriate identification of the bacteria. Antibiograms must be interpreted with respect to the different resistance mechanisms and their respective frequency, as is reported for Enterobacter species, even if routine in vitro antibiotic susceptibility testing has not identified resistance.

Of note, the species formerly known as Enterobacter aerogenes was reassigned to the genus Klebsiella (now known as Klebsiella aerogenes) in 2017. [3] Much of the literature regarding Enterobacter species prior to this date includes data attributable to K aerogenes. Nevertheless, conclusions regarding E cloacae complex and the individual species (eg, E cloacae, Enterobacter hormaechei) remain valid.


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