Enterobacter Cloacae Septicemia

Written by martine altidor
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Enterobacter Cloacae Septicemia
Culture media used to grow bacteria (Bacteria Colonies image by ggw from Fotolia.com)

Septicaemia is defined as the presence of pathogenic microorganisms in the blood (e.g., bacteria and viruses) actively replicating and causing a whole-body inflammatory response. Clinical symptoms which present are usually fever, tachycardia and organ dysfunction. Septicaemia is a frequent cause of death in immuno-compromised patients.

Enterobacter cloacae is a clinically significant hospital-acquired bacteria, especially responsible for intravenous line contamination and urinary tract infections. Endocarditis and lower respiratory tract infections are also caused by the bacteria.

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Classification

The Enterobacter cloacae species belongs to the family of Enterobacteriaceae, genus Enterobacter. Enterobacter cloacae is a moderately sized (0.3 to 1.0 x 1.0 to 6.0 µm), gram negative, facultative anaerobic bacilli with peritrichous flagella (i.e., flagella surrounding the entire surface of the bacteria allowing it to move). The facultative anaerobic capacity of Enterobacter cloacae allows it to respire normally when oxygen levels are low or depleted.

Enterobacter cloacae is found globally in both adult and neonatal intensive care units. However, the organism naturally occurs in contaminated water, sewage, soil, meat, and as part of the normal flora of the human gut.

Clinical Significance

Enterobacter cloacae is an opportunistic bacteria, meaning, if the patient's immune system is weakened, the bacteria will take this advantage and replicate, releasing toxins and stressing the lungs, kidneys, heart, skin, and other tissues. The bacteria is hugely responsible for frequent and aggressive nosocomial (hospital-acquired) infections, with a high mortality and morbidity rate. This rate is hugely determined on whatever underlying condition the patient is suffering from (e.g., cancer, HIV). Reported rates of mortality has been estimated to range from six to 40 per cent, with some hospitals estimating as high as 87 per cent.

Septicaemia caused by this bacteria is made complicated by its inherently resistant genomics. Antibiotic therapy can be rendered completely ineffective because of its ability to resist many antibitocs such as narrow-spectrum penicillins.

Transmission

The main route of acquired septic infection is typically through a break in the skin or an infected area allowing bacteria to enter the bloodstream. With a septic patient, the source of infection may be a contaminated intravenous line (i.e., central venous lines, urinary catheters), burns, gastrointestinal ulcers, surgical wound, pelvic abscess or urinary tract.

Hospital environments are key in transmitting this bacteria to the patient. As bacteria are usually acquired through human to human contact, it is usually advised that proper hand washing is performed to reduce the spread of the bacteria. There have been investigative reports which have found Enterobacter cloacae on hospital equipment, stethoscopes, floors, patient bathrooms and even water supplies.

Pathology

Septicaemia is a result of the patient's own immune response to a bacteria. The mechanism which causes septicaemia is highly involved, but in simple terms, an excessive inflammatory response causes the symptoms. It causes a myriad of complex changes at cellular, humoral and physiological levels.

The presence of the bacteria and its lipopolysaccharides stimulate the body's white blood cells to release cytokines, and additionally complement factors and antibodies. These mediators act in a haphazard way, with aims of quelling the invading pathogen. In their aim to help the host, they directly cause capillary leakage, organ dysfunction and shock. The combined effect of white blood cells and cytokines seeking to destroy the bacteria result in the extensive systemic effects.

Treatment

Antibiotic therapy with Enterobacter cloacae septicaemia is a very complicated issue. As previously stated, the bacteria is highly resistant to many established antibiotics for Gram-negative bacilli species. A physician will usually prescribe treatment based on laboratory results, the patients own sensitivity to a drug, and also if there is an underlying condition. Typical antibiotics are: Cefepime and Gentamicin.

Treatment not only focuses on antibiotics, but also on maintaining a hygienic stance to minimise any potential infections. This means, that intravenous lines are checked and cleaned regularly, along with any abscesses or wounds.

Enterobacter Cloacae Septicemia
Antibiotic resistance a big factor in treatment (pills image by Bradlee Mauer from Fotolia.com)

Warning

A physician has the medical knowledge and training to advise on diagnosis and treatments for septicaemia.

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