From the Guidelines
The recommended treatment for Enterobacter gergoviae infections is ceftazidime/avibactam or meropenem/vaborbactam as first-line therapy, due to their efficacy against carbapenem-resistant Enterobacterales (CRE) and improved clinical outcomes compared to traditional antibiotic regimens 1.
Key Considerations
- The choice between ceftazidime/avibactam and meropenem/vaborbactam should consider the site of infection, with meropenem/vaborbactam potentially preferred for pneumonia due to its high epithelial lining fluid (ELF) concentrations 1.
- Local epidemiology and the emergence of ceftazidime/avibactam resistance in KPC-producing isolates should also be considered when selecting a treatment regimen 1.
- Imipenem/relebactam and cefiderocol may be considered as alternative options, although clinical studies on their efficacy in Enterobacter gergoviae infections are limited 1.
Treatment Approach
- Antibiotic susceptibility testing is crucial before initiating treatment, as Enterobacter gergoviae frequently exhibits resistance to multiple antibiotics 1.
- Treatment duration should be individualized based on the infection site and severity, with a typical duration of 7-14 days.
- Source control through drainage of abscesses or removal of infected devices is essential when applicable.
- Treatment should be adjusted based on clinical response and culture results, with de-escalation to narrower-spectrum antibiotics when possible to reduce resistance development.
From the FDA Drug Label
- 5 Complicated Intra-abdominal Infections Cefepime Injection is indicated for complicated intra-abdominal infections (used in combination with metronidazole) caused by Escherichia coli, viridans group streptococci, Pseudomonas aeruginosa, Klebsiella pneumoniae, Enterobacter species, or Bacteroides fragilis Table 1: Recommended Dosage Schedule for Cefepime Injection in Adult Patients with Creatinine Clearance (CrCL) Greater Than 60 mL/min Site and Type of Infection Dose FrequencyDuration (days) Moderate to Severe Pneumonia due to S. pneumoniae, P. aeruginosa*, K pneumoniae, or Enterobacter species 1-2 g IV Every 8-12 hours 10
The recommended treatment for Enterobacter gergoviae infections is Cefepime Injection. The dosage for adults with creatinine clearance greater than 60 mL/min is:
- 1-2 g IV every 8-12 hours for moderate to severe pneumonia due to Enterobacter species. 2
From the Research
Treatment Options for Enterobacter gergoviae Infections
The recommended treatment for Enterobacter gergoviae infections is based on the susceptibility profile of the strain. According to a study published in 2002 3, Enterobacter gergoviae strains are naturally sensitive or intermediate to:
- Tetracyclines
- Aminoglycosides
- Numerous beta-lactams (acylureidopenicillins, ticarcillin, ampicillin/sulbactam, several cephalosporins, carbapenems, aztreonam)
- Quinolones
- Antifolates
- Chloramphenicol
- Nitrofurantoin
Resistance Patterns
Enterobacter gergoviae strains have been found to be naturally resistant to:
- Penicillin G
- Oxacillin
- Several macrolides
- Lincosamides
- Streptogramins
- Glycopeptides
- Rifampicin
- Fusidic acid
Emerging Resistance and Treatment Options
In recent years, there has been an increase in carbapenem-resistant Enterobacteriaceae, including Enterobacter gergoviae 4, 5, 6, 7. In such cases, treatment options may include:
- Combination therapy with carbapenems and other antibiotics (e.g., colistin, tigecycline, aminoglycosides)
- Use of newer antibiotics, such as ceftazidime-avibactam, meropenem-vaborbactam, imipenem-relebactam, plazomicin, cefiderocol, eravacycline, and aztreonam-avibactam
- High-dose and combination strategies to maximize treatment success
Key Considerations
When treating Enterobacter gergoviae infections, it is essential to consider the following: