eMedicine Specialties > Infectious Diseases > Bacterial Infections

Enterobacter Infections: Follow-up

Author: Susan L Fraser, MD, Infectious Diseases Service, Walter Reed Army Medical Center; Chairman, Infection Control Committee; Associate Professor of Medicine, Uniformed Services University of the Health Sciences
Coauthor(s): Michael Arnett, MD, Resident, Department of Medicine, Tripler Army Medical Center; Christian P Sinave, MD, Associate Professor, Department of Medical Microbiology and Infectious Diseases, University of Sherbrooke, Canada
Contributor Information and Disclosures

Updated: Aug 28, 2008

Follow-up

Inpatient & Outpatient Medications

  • Enterobacter infections that are improving may warrant switch to an oral medication such as a quinolone or TMP-SMZ in accordance with sensitivity testing, when feasible. Ciprofloxacin (500-750 mg PO q12h) is an acceptable alternative in patients who are able to tolerate oral medication as long as they are not coadministered products that contain divalent cations (calcium or dairy products, iron, magnesium, zinc). No documentation exists for managing endocarditis with oral medications.
  • Some patients with Enterobacter infections may require longer therapy with intravenous antibiotics. In those who meet criteria for home antibiotic therapy, the selected intravenous medication should not usually require more than 3-times-daily infusion. Ertapenem and tigecycline may be considered for such patients in conjunction with infectious disease specialists and home infusion therapy experts.

Deterrence/Prevention

  • When hospital (ICU) outbreaks of Enterobacter infections occur, isolation and barrier protection should be implemented. Isolation precautions should also be implemented when a multidrug-resistant organism is isolated.
  • Hand washing or use of alcohol or other disinfecting hand gels by health care workers between contacts with patients prevents transmission of these and other nosocomial bacteria. This is particularly true in ICUs.
  • Prior antibiotic administration is a major factor for colonization and secondary infections with these multiple-antibiotic–resistant organisms. Clinicians are advised to avoid unnecessary administration of antimicrobial agents or to avoid unnecessary prolonged administration. For surgical prophylaxis, administration of antibiotics for longer than 24 hours is rarely justifiable.
  • Education programs for physicians and hospital personnel regarding risk reduction for transmission of Enterobacter species and other nosocomial pathogens should be implemented in every hospital. This is usually the responsibility of the infection-control team.
  • Comprehensive guidelines regarding isolation for and prevention of nosocomial infections and management of infections by multidrug-resistant organisms (eg, ESBL-producing Enterobacter species) in health care settings are available at the Centers for Disease Control Web site (Guideline for Isolation Precautions: Preventing Transmission of Infectious Agents in Healthcare Settings 2007; Management of Multidrug-Resistant Organisms In Healthcare Settings, 2006).

Prognosis

See Mortality/Morbidity.

Miscellaneous

Medicolegal Pitfalls

Failure to select appropriate antibiotics for treatment is a significant problem with potential legal implications. Selecting agents based only on susceptibility testing reports could be dangerous because rapid resistance could develop during therapy. Consultation with an infectious diseases specialist can be of tremendous help in determining appropriate antibiotic treatment.

Special Concerns

  • Bacterial resistance to antibiotics continues to be a significant threat. Many strains of Enterobacter species are already resistant to many antibiotics. The presence of inducible resistance genes on plasmids in other members of the Enterobacteriaceae family is concerning for the possibility of transfer of genes between bacteria, resulting in the development of further resistance in Enterobacter species.
  • Good antibiotic prescription, good monitoring of bacterial resistance, and good infection-control practices are among the most important measures that should be in place in each hospital. Laboratory microbiologists, infectious diseases clinicians, pharmacists, hospital epidemiologists, and hospital administrators can assist in reducing the rates of nosocomial infections.
 


More on Enterobacter Infections

Overview: Enterobacter Infections
Differential Diagnoses & Workup: Enterobacter Infections
Treatment & Medication: Enterobacter Infections
Follow-up: Enterobacter Infections
Multimedia: Enterobacter Infections
References
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Further Reading

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Keywords

Enterobacter infections, Enterobacter cloacae infection, Enterobacter aerogenes infection, Enterobacter sakazakii infection, Enterobacteriaceae infections, E cloacae, E aerogenes, E sakazakii, Enterobacter bacteremia, Enterobacter lower respiratory tract infection, Enterobacter skin infection, Enterobacter soft-tissue infection, Enterobacter urinary tract infection, Enterobacter UTI, Enterobacter endocarditis, Enterobacter intra-abdominal infection, Enterobacter intraabdominal infection, Enterobacter septic arthritis, Enterobacter osteomyelitis, Enterobacter ophthalmic infections, nosocomial Enterobacter infection, Enterobacter pneumonia, Enterobacter taylorae, E taylorae, Enterobacter cancerogenus, E cancerogenus

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Contributor Information and Disclosures

Author

Susan L Fraser, MD, Infectious Diseases Service, Walter Reed Army Medical Center; Chairman, Infection Control Committee; Associate Professor of Medicine, Uniformed Services University of the Health Sciences
Susan L Fraser, MD is a member of the following medical societies: American College of Physicians, American Liver Foundation, American Society for Microbiology, American Society of Tropical Medicine and Hygiene, Armed Forces Infectious Diseases Society, and Infectious Diseases Society of America
Disclosure: Nothing to disclose.

Coauthor(s)

Michael Arnett, MD, Resident, Department of Medicine, Tripler Army Medical Center
Disclosure: Nothing to disclose.

Christian P Sinave, MD, Associate Professor, Department of Medical Microbiology and Infectious Diseases, University of Sherbrooke, Canada
Christian P Sinave, MD is a member of the following medical societies: American Society for Microbiology and Canadian Infectious Disease Society
Disclosure: Nothing to disclose.

Medical Editor

Maria D Mileno, MD, Assistant Professor, Department of Internal Medicine, Division of Infectious Diseases, Brown University
Maria D Mileno, MD is a member of the following medical societies: Alpha Omega Alpha, American College of Physicians, American Society of Tropical Medicine and Hygiene, Infectious Diseases Society of America, International Society of Travel Medicine, and Sigma Xi
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: Nothing to disclose.

Managing Editor

Joseph F John Jr, MD, FACP, FIDSA, FSHEA, Clinical Professor of Medicine, Molecular Genetics and Microbiology, Medical University of South Carolina; Associate Chief of Staff for Education, Ralph H Johnson Veterans Affairs Medical Center
Disclosure: BioMerieux Honoraria Review panel membership; Cubist Honoraria Review panel membership; Pfizer Honoraria Speaking and teaching; Merck Stock dividends stock holdings

CME Editor

Eleftherios Mylonakis, MD, Clinical and Research Fellow, Department of Internal Medicine, Division of Infectious Diseases, Massachusetts General Hospital
Eleftherios Mylonakis, MD is a member of the following medical societies: American Association for the Advancement of Science, American College of Physicians, American Society for Microbiology, and Infectious Diseases Society of America
Disclosure: Nothing to disclose.

Chief Editor

Burke A Cunha, MD, Professor of Medicine, State University of New York School of Medicine at Stony Brook; Chief, Infectious Disease Division, Winthrop-University Hospital
Burke A Cunha, MD is a member of the following medical societies: American College of Chest Physicians, American College of Physicians, and Infectious Diseases Society of America
Disclosure: Nothing to disclose.

 
 
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