Case report of enterobacter cloacae producing IMP-8 carbapenemase isolated from secretions of burn patients and diabetes patients with diabetic foot

Abstract

Introduction: With the widespread use of cephalosporins, Enterobacter cloacae has become an increasingly important pathogen of nosocomial infections, which causes bacterial infectious diseases involving multiple organ systems. The presence of carbapenemresistant strains has resulted in problems in the current clinical anti-infective treatment. The current study reports on four cases of carbapenem-resistant E. cloacae secretion infection in order to provide suggestions for the detection and treatment of these pathogen infections. Case Presentation: Investigation of 4 cases was conducted at tertiary care hospitals, and baseline data, treatment and outcomes were collected for patients with carbapenem-resistant E. cloacae infection. The strains of burn injury and diabetic foot infection were retrievedfromspecimens by culture-based methods, andantibiotic sensitivity testwasconductedonVitek 2. All strainsshowedminimum inhibitory concentration (MIC) values for ertapenem, imipenem, and meropenem of less than 4 µg/mL. The four strains of E. cloacae produced IMP-8 type carbapenemase confirmed by PCR and sequence analysis. After the selection of reasonable antibiotic treatment, the patient‘s condition had improved and they were discharged from the hospital. Conclusions: Low MIC value makes it difficult to detect IMP-8-harboring strains by traditional susceptibility test; molecular biology techniques may be mandatory for detection of carbapenem resistant isolates. It is very important to treat patients with reasonable antimicrobial based on susceptibility results.