Treatment of Enterobacter cloacae UTI

Key Treatment Principles

The World Journal of Emergency Surgery recommends using a carbapenem (meropenem or imipenem) or fourth-generation cephalosporin (cefepime) for non-carbapenem-resistant Enterobacter cloacae UTI, based on susceptibility testing, avoiding third-generation cephalosporins due to high resistance rates 1, 2
First and second-generation cephalosporins are generally not effective against Enterobacter infections, according to the World Journal of Emergency Surgery 1, 2
Third-generation cephalosporins should not be used due to increased likelihood of resistance, particularly for E. cloacae and E. aerogenes, as stated in the World Journal of Emergency Surgery 1, 2
Cefepime can be used if Extended-Spectrum beta-lactamase (ESBL) is absent, as recommended by the World Journal of Emergency Surgery 1

Meropenem and imipenem are effective against E. cloacae and E. aerogenes, according to the World Journal of Emergency Surgery 1, 2
Carbapenems represent a valid therapeutic option for multidrug-resistant Enterobacter infections, as stated in the World Journal of Emergency Surgery 1

Ceftazidime-avibactam 2.5 g IV every 8 hours is a preferred newer agent for complicated UTI (cUTI), as recommended by the Journal of Microbiology, Immunology and Infection 3, 4, 5
Meropenem-vaborbactam 4 g IV every 8 hours is a preferred newer agent for complicated UTI (cUTI), according to the Journal of Microbiology, Immunology and Infection 3, 4, 5
Imipenem-cilastatin-relebactam 1.25 g IV every 6 hours is a preferred newer agent for complicated UTI (cUTI), as stated in the Journal of Microbiology, Immunology and Infection 3, 4, 5
Plazomicin 15 mg/kg IV every 12 hours is a preferred newer agent for complicated UTI (cUTI), according to the Journal of Microbiology, Immunology and Infection 4, 6, 5
Single-dose aminoglycoside (amikacin or gentamicin) is recommended for simple cystitis due to CRE, as stated in the Journal of Microbiology, Immunology and Infection 3, 6, 7
Aminoglycosides achieve urinary concentrations 25- to 100-fold higher than plasma levels, making them ideal for UTI treatment, according to the Journal of Microbiology, Immunology and Infection 6, 7
Meta-analysis of 13,804 patients showed microbiologic cure rates of 87-100% with single-dose aminoglycoside for lower UTI, as reported in the Journal of Microbiology, Immunology and Infection 6, 7

IV fosfomycin for non-severe cUTI without septic shock is an alternative option, as recommended by Clinical Microbiology and Infection and the Journal of Microbiology, Immunology and Infection 8, 7
Polymyxins (colistin), tigecycline, or fosfomycin for carbapenem-resistant strains are alternative options, according to the World Journal of Emergency Surgery and Clinical Microbiology and Infection 1, 2, 8
Avoid tigecycline monotherapy for bloodstream infections, as stated in Clinical Microbiology and Infection 8

Always obtain susceptibility testing before finalizing therapy, as recommended by the Journal of Microbiology, Immunology and Infection and the World Journal of Emergency Surgery 5, 1
Reserve newer β-lactam/β-lactamase inhibitor combinations for extensively resistant bacteria, according to Clinical Microbiology and Infection 8
Infectious disease consultation is highly recommended for MDRO infections, as stated in the Journal of Microbiology, Immunology and Infection 5
Consider prolonged infusion of β-lactams for pathogens with high MIC, as recommended by the Journal of Microbiology, Immunology and Infection 5
Adjust treatment duration based on clinical response and source control, according to the Journal of Microbiology, Immunology and Infection 5