Enterobacter cloacae: an “ICU bug” causing community acquired necrotizing meningo-encephalitis

Abstract

Enterobacter cloacae is a gram negative bacillus that is ubiquitous as a contaminant and a pathogen in adult, paediatric, and neonatal ICUs. Its transmission is almost exclusively nosocomial with community acquired infection reported rarely. We report a case of community acquired, rapidly progressive E. cloacae meningo-encephalitis in a neonate. A three-week-old term infant presented from home, having been discharged from hospital within two days of delivery. She rapidly progressed to multi-organ dysfunction. Initial CT of her brain showed evidence of severe hypoxic changes and herniation of the frontal lobes through the anterior fontanelle. Care was withdrawn 72 hours after admission. Post mortem examination confirmed E.cloacae meningo-encephalitis as a cause of her death. The baby had not been in a critical care environment at any time before admission, making it highly likely to have been a community acquired infection. Transmission of the organism may have been vertical as maternal transmission with intestinal colonization of neonates with E. cloacae has previously been reported. This case confirms that infection with E. cloacae should be included in the differential diagnosis of any severely ill neonate presenting from the community, and antimicrobial therapy should be optimized accordingly.

Bacterial spectrum of neonatal septicemia with their antibiogram with reference to various predisposing factors in a tertiary care hospital in Southern India

“…Enterobacter cloacae may be acquiring more clinical significance by replacing other Gram-negative organisms in neonatal intensive care units. [20][21][22] Role of Citrobacter freundii (17.07%) and Citrobacter diversus (2.43%) in neonatal sepsis was reported. [23] Comparatively, 11.58% of Citrobacter freundii and 5.26% of Citrobacter koseri were isolated in this study.…”

Enterobacter cloacae Complex Meningitis in a Full-term Neonate

“…Review of the literature for Enterobacter species infections in neonates only reveals 2 cases that occurred in neonates without an NICU stay or predisposing factors. 10,11 The patient in this case was born full term, had an uncomplicated delivery and hospital stay, and was discharged home less than 48 hours after birth. There were no known risk factors for neonatal infection, such as low birth weight, prematurity, maternal intrapartum infection, or prolonged rupture of membranes.…”

Distribution and diversity of type VI secretion system clusters in Enterobacter bugandensis and Enterobacter cloacae

“…Currently, there are 56 species within the genus Enterobacter, 22 of which are published with accepted names [List of Prokaryotic Names with Standing in Nomenclature (accessed: 7 June 2023); https://lpsn.dsmz.de/genus/ Enterobacter] [47]. Although not all species are pathogenic, some have emerged as important nosocomial pathogens and are generally referred to as the Enterobacter cloacae complex [48][49][50][51]. The Enterobacter T6SS has been investigated in E. cloacae type strain ATCC 13047, which possesses two T6SS clusters (termed T6SS-1 and T6SS-2) utilized for gut colonization, bacterial competition, biofilm formation and epithelial cell adherence [40].…”