What are the isolation measures for Enterobacter cloacae (E. cloacae) Urinary Tract Infection (UTI)?

From the Guidelines

Patients with Enterobacter cloacae urinary tract infections (UTIs) should be managed with bundle interventions including contact isolation, as this approach has been shown to reduce the rate of infection or colonization in hospitalized patients. The most recent and highest quality study, published in 2023 1, recommends adopting a bundle intervention scheme including single room or cohorting isolation for patients with carbapenem-resistant Gram-negative bacilli (CRGNB) infections or colonization in hospital settings. This approach is supported by observational studies that consistently show a reduction in the rate of CRGNB infection or colonization with the implementation of bundle management schemes including contact isolation.

Key Considerations for Isolation Measures

• Single room isolation is preferred, and separate toilet facilities should be provided for patients infected or colonized with CRGNB.
• When resources are limited, priority should be given to patients with fecal or urinary incontinence, those using invasive devices or equipment, or those with continuous wound secretion.
• Nursing staff designated to care for patients with CRGNB infections or colonization should not participate in caring for other patients.
• Caregivers should not be permitted to stay in the ward to care for isolated patients.

Rationale for Recommendation

The recommendation is based on the available evidence from observational studies, which consistently show that bundle management schemes including contact isolation can reduce the rate of CRGNB infection or colonization in hospitalized patients 1. Although the quality of the evidence is low, expert experience and clinical practice support the adoption of bundle management schemes including isolation. The potential benefits of this approach, including reduced transmission of infection, outweigh the potential harms, such as increased consumption of health resources and psychological discomfort for patients.

Additional Measures

In addition to isolation measures, standard contact precautions should be implemented, including proper hand hygiene, wearing gloves when handling bodily fluids, and using gowns if there is a risk of clothing contamination. Environmental cleaning of high-touch surfaces with hospital-approved disinfectants is also essential. Patient education about proper hygiene, including handwashing after using the bathroom, is important to prevent transmission. These measures are effective because Enterobacter cloacae spreads primarily through direct contact with contaminated surfaces or via the hands of healthcare workers.

From the FDA Drug Label

The FDA drug label does not answer the question.

From the Research

Isolation Measures for Enterobacter Cloacae UTI

• The studies provided do not directly address isolation measures for Enterobacter cloacae UTI, but rather focus on the treatment and susceptibility of Enterobacter cloacae to various antibiotics 2, 3, 4, 5, 6.
• However, it can be inferred that proper isolation measures are crucial in preventing the spread of Enterobacter cloacae in healthcare settings, particularly in neonatal intensive care units (NICUs) where the bacteria can cause nosocomial outbreaks 2.
• The implementation of intensive biocleaning and education of medical staff can help reduce the incidence of Enterobacter cloacae infections, but may not significantly decrease patient colonization 2.
• The use of antibiotics such as cefepime, imipenem, and carbapenems may be effective in treating Enterobacter cloacae infections, but the choice of antibiotic should be guided by susceptibility testing and clinical judgment 3, 4, 5, 6.
• The development of resistance to antibiotics is a major concern, and the use of antibiotics should be carefully monitored and controlled to prevent the emergence of resistant strains 4, 5, 6.

Treatment Options

• Cefepime is a therapeutic alternative for cefepime-susceptible Enterobacter cloacae bacteremia, but may not be effective against cefepime-susceptible dose-dependent (SDD) isolates 3.
• Imipenem and carbapenems are effective against Enterobacter cloacae, but may not be effective against strains producing carbapenem-hydrolyzing beta-lactamases 5.
• Cefepime is effective against AmpC beta-lactamase-producing Enterobacterales bloodstream infections, and may be a safe treatment strategy for clinically stable patients without initial renal impairment or increased susceptibility to neurological adverse events 6.

Susceptibility and Resistance

• Enterobacter cloacae isolates have shown a significant decrease in susceptibility to antibiotics over time, with gentamicin, ciprofloxacin, imipenem, and cefepime being the most effective antibiotics 4.
• The development of resistance to antibiotics is a major concern, and the use of antibiotics should be carefully monitored and controlled to prevent the emergence of resistant strains 4, 5, 6.