What is the treatment for Enterobacter cloacae complex urinary tract infection (UTI)?

Medical Advisory BoardAll articles are reviewed for accuracy by our Medical Advisory Board
Educational purpose only • Exercise caution as content is pending human review
Article Review Status
Submitted
Under Review
Approved

Last updated: April 23, 2025 • View editorial policy

Personalize

Help us tailor your experience

Which best describes you? Your choice helps us use language that's most understandable for you.

From the Guidelines

For the treatment of Enterobacter cloacae complex urinary tract infections (UTIs), a carbapenem such as meropenem (1g IV every 8 hours) or imipenem (500mg IV every 6 hours) is recommended as the first-line option for 7-14 days, depending on infection severity, as per the latest guidelines 1. This recommendation is based on the European Association of Urology guidelines on urological infections, which suggest using a combination of antibiotics for complicated UTIs, including a third-generation cephalosporin plus an aminoglycoside, or an intravenous third-generation cephalosporin as empirical treatment for complicated UTI with systemic symptoms 1. However, for Enterobacter cloacae complex specifically, carbapenems are preferred due to their broad-spectrum activity and effectiveness against this pathogen, as supported by the European Society of Clinical Microbiology and Infectious Diseases (ESCMID) guidelines for the treatment of infections caused by multidrug-resistant gram-negative bacilli 1. Some key points to consider in the treatment of Enterobacter cloacae complex UTIs include:

  • The use of ciprofloxacin is only recommended if the local resistance rate is <10% and the patient does not require hospitalization 1.
  • Managing any urological abnormality and/or underlying complicating factors is crucial for effective treatment 1.
  • Antimicrobial susceptibility testing should always guide treatment, as resistance patterns can vary 1.
  • For complicated infections or those with systemic symptoms, initial empiric therapy with a carbapenem is recommended until susceptibility results are available 1.
  • Alternatives to carbapenems, such as fluoroquinolones or cefepime, may be considered based on susceptibility results and the severity of the infection 1. It is essential to note that the treatment of Enterobacter cloacae complex UTIs should prioritize the use of effective antibiotics while minimizing the risk of resistance development, as emphasized by the ESCMID guidelines 1.

From the FDA Drug Label

  1. 10 Complicated Urinary Tract Infections: 10 Day Treatment Regimen Levofloxacin tablets are indicated for the treatment of complicated urinary tract infections (mild to moderate) due to Enterococcus faecalis, Enterobacter cloacae, Escherichia coli, Klebsiella pneumoniae, Proteus mirabilis, or Pseudomonas aeruginosa [see Clinical Studies (14.8)]. Mild to Moderate Uncomplicated or Complicated Urinary Tract Infections, including pyelonephritis, due to E. coli, K. pneumoniae, or P. mirabilis† 0. 5 to 1 gIV/IM¶ Every 12 hours 7 to 10 Severe Uncomplicated or Complicated Urinary Tract Infections, including pyelonephritis, due to E. coli or K. pneumoniae† 2 g IV Every 12 hours 10 Levofloxacin and cefepime are both effective against Enterobacter cloacae complex UTI.
  • Levofloxacin is indicated for the treatment of complicated urinary tract infections due to Enterobacter cloacae.
  • Cefepime is effective against Enterobacter species and can be used for the treatment of complicated urinary tract infections. 2 3

From the Research

Enterobacter cloacae Complex UTI

  • Enterobacter cloacae complex is a common cause of urinary tract infections (UTIs), particularly complicated UTIs 4, 5, 6, 7.
  • The complex includes several species, such as Enterobacter cloacae, Enterobacter asburiae, Enterobacter hormaechei, Enterobacter kobei, Enterobacter ludwigii, and Enterobacter nimipressuralis 6.
  • These bacteria can exhibit resistance to multiple antibiotics, including beta-lactams, aminoglycosides, and fluoroquinolones 5, 6, 7, 8.

Treatment Options

  • Cefiderocol, a cephalosporin antibiotic, has been approved for the treatment of complicated UTIs caused by Enterobacter cloacae complex, among other Gram-negative bacteria 4.
  • Meropenem-vaborbactam, a combination of a carbapenem and a beta-lactamase inhibitor, has also been shown to be effective against Enterobacter cloacae complex and other carbapenem-resistant Enterobacteriaceae (CRE) 7.
  • Other treatment options, such as cefepime, ceftazidime-avibactam, and fosfomycin, may also be effective, but their use should be guided by susceptibility testing and clinical experience 5, 8.

Resistance Mechanisms

  • Enterobacter cloacae complex can develop resistance to antibiotics through various mechanisms, including the production of beta-lactamases, such as AmpC beta-lactamases, and the acquisition of resistance genes 6, 8.
  • The use of antibiotics, such as cefepime, meropenem, and ceftazidime-avibactam, can select for resistant isolates with diverse mechanisms, including alterations in AmpC, OmpC, and TetA/AcrR regulators 8.
  • The development of resistance to one antibiotic can also lead to cross-resistance to other beta-lactams, making treatment more challenging 8.

References

1
Guideline

Guideline Directed Topic Overview

Dr.Oracle Medical Advisory Board & Editors, 2025

Related Questions

What is Cefiderocol used for?
Does cefdinir (Cefdinir) cover Escherichia coli (E. coli)?
Does Fetroja (Cefiderocol) cover multidrug-resistant (MDR) Pseudomonas aeruginosa?
Why is Augmentin (amoxicillin-clavulanate) prescribed in combination with Ciprofloxacin for a wound culture positive for Enterobacter cloacae that is sensitive to these antibiotics?
Is ciprofloxacin (Cipro) effective against Morganella morganii infections?
What is the cause of persistent severe neck pain in a patient with Hashimoto's thyroiditis, initially presenting with hyperthyroidism and now with hypothyroidism, despite treatment with Synthroid (levothyroxine)?
What is the differential diagnosis for a recurrent, tender dermatofibroma (benign skin growth) on the lip in a pregnant patient, and what features should the histopathologist re-examine in the biopsy specimen?
What is the treatment for chemical burns to the dorsal surface of the feet, presenting with swelling and pain 3 days post-exposure?
What are Fordyce spots (sebaceous gland hyperplasia)?
What is the initial diagnostic workup for Human Immunodeficiency Virus (HIV) and Hepatitis C (Hep C)?
What is the diagnosis for a 26-year-old female presenting with nausea, emesis, intermittent fevers, upper abdominal pain, watery loose stools 2-3 times a day, and fatigue, despite difficulty eating and keeping food down for over one week?

Professional Medical Disclaimer

This information is intended for healthcare professionals. Any medical decision-making should rely on clinical judgment and independently verified information. The content provided herein does not replace professional discretion and should be considered supplementary to established clinical guidelines. Healthcare providers should verify all information against primary literature and current practice standards before application in patient care. Dr.Oracle assumes no liability for clinical decisions based on this content.

Have a follow-up question?

Our Medical A.I. is used by practicing medical doctors at top research institutions around the world. Ask any follow up question and get world-class guideline-backed answers instantly.

Ask Question