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Enterobacter

Enterobacter is a of Gram-negative, rod-shaped, facultatively anaerobic bacteria belonging to the family . These non-spore-forming microbes are typically motile via peritrichous flagella, urease-positive, and capable of fermenting , with factors including adhesins and (LPS) capsules. The of Enterobacter has undergone revisions, with the genus originally described in 1960 and now encompassing 28 , though some have been reclassified to other genera such as Cronobacter (e.g., former E. sakazakii) and Klebsiella (e.g., E. aerogenes reclassified as K. aerogenes). Clinically relevant within the Enterobacter cloacae complex, which includes seven closely related taxa, dominate human infections; notable examples are E. cloacae, E. hormaechei, and E. ludwigii. Recent genomic studies have identified new like E. bugandensis and refined phylogenetic relationships through whole-genome sequencing. Enterobacter species are opportunistic , primarily associated with nosocomial infections in immunocompromised patients, neonates, and those in intensive care units. They historically accounted for 5-7% of hospital-acquired bacteremias (based on data from 1976-1989) and are the third most common respiratory in ICUs. Common clinical manifestations include urinary tract infections, bacteremia, lower infections, skin and soft tissue infections, , and , often linked to contaminated medical devices or hospital environments. is enhanced by factors such as flagella for , endotoxins, biofilms, and type III secretion systems. A major concern with Enterobacter is its propensity for antimicrobial resistance, with many strains exhibiting multidrug-resistant (MDR) phenotypes due to mechanisms like AmpC β-lactamases, extended-spectrum β-lactamases (ESBLs), porin loss, and efflux pumps such as AcrAB-TolC. Carbapenem-resistant Enterobacteriaceae (CRE), including those producing carbapenemases like NDM-1 and KPC, are classified as a critical priority by the World Health Organization, contributing to challenges in treatment and outbreaks. Approximately 50% of β-lactam resistance in these bacteria is attributed to AmpC production (as of 2019), and plasmid-mediated quinolone resistance affects up to 60% of strains (as of 2019).

Overview

Description

Enterobacter is a of Gram-negative, rod-shaped that are facultatively , belonging to the family within the order . These motile , typically measuring 2–3 μm in length, are non-spore-forming and oxidase-negative, capable of fermenting glucose with gas production. They are ubiquitous environmental microbes, commonly isolated from sources such as , , , and plant materials, and also reside as part of the normal human gastrointestinal flora. As opportunistic pathogens, Enterobacter species are prominent causes of nosocomial infections, including bacteremia, , urinary tract infections, and infections, particularly in immunocompromised or hospitalized patients. They form part of the group of , notorious for their ability to evade antibiotics through mechanisms like efflux pumps and production. Clinically, Enterobacter accounts for approximately 5% of nosocomial bacteremia cases, with E. cloacae being the most frequently implicated species; is enhanced by factors such as formation, which aids persistence on medical devices. The adaptability of Enterobacter is exemplified by the isolation of multidrug-resistant E. bugandensis strains from the in 2018, demonstrating their resilience in extreme, microgravity environments with limited nutrients and .

Historical Background

The first descriptions of what would later be classified within the Enterobacter trace back to the late 19th century, when Edwin O. Jordan isolated Bacillus cloacae in 1890 from environmental sources, including water and samples associated with contamination. This organism was initially characterized as a Gram-negative rod capable of fermenting and producing gas, marking an early recognition of its environmental ubiquity. Subsequent taxonomic revisions in the early reclassified it under Bacterium cloacae, reflecting evolving understanding of its biochemical properties and distinction from other enteric . The modern genus Enterobacter was formally proposed in 1960 by E. Hormaeche and P. R. Edwards to accommodate motile, ornithine-positive members previously grouped under Aerobacter, based on differential biochemical tests such as decarboxylase activity and motility. This separation addressed inconsistencies in the Aerobacter genus, which included both plant-associated and human-derived strains, and established Enterobacter as a distinct taxon within the family Enterobacteriaceae. Over the following decades, the genus expanded through additional species descriptions, driven by phenotypic and later molecular characterizations. Significant taxonomic advancements occurred in the , prompted by genomic data. In 2016, a comprehensive phylogenetic analysis led to the proposal of the order to replace Enterobacteriales, reorganizing the family into multiple families, including , to better reflect evolutionary relationships. A 2019 review further refined Enterobacter species delineation using whole-genome sequencing, incorporating average nucleotide identity and digital DNA-DNA hybridization to update classifications and resolve ambiguities in the Enterobacter cloacae complex. Subsequent genomic studies, including a 2020 analysis of 1,997 genomes that proposed Enterobacter quasiroggenkampii sp. nov. and Enterobacter quasimori sp. nov., and a 2024 description of Enterobacter chinensis sp. nov. and Enterobacter huaxiensis sp. nov. from soil, have continued to expand and refine the genus's as of 2025. Key milestones in Enterobacter research include its recognition as a nosocomial in the 1970s, following outbreaks of bacteremia linked to contaminated intravenous fluids, which underscored its role in hospital-acquired infections among immunocompromised patients. In , a study isolated B29 from the gut of a morbidly obese individual, demonstrating its capacity to induce and in germ-free mice through endotoxin production and . The 2018 discovery of multi-drug resistant Enterobacter bugandensis strains on the revealed adaptations enhancing and resistance under microgravity and radiation stress, raising concerns for . Awareness of antimicrobial resistance evolved notably in the early 2000s, with initial reports of carbapenem-resistant strains producing metallo-β-lactamases like VIM, signaling the emergence of difficult-to-treat infections.

Taxonomy and Classification

Phylogenetic Position

Enterobacter is classified within the phylum (formerly known as Proteobacteria), class , order , and family . This positioning reflects its membership in a diverse group of Gram-negative, facultatively characterized by oxidase-negative reactions and peritrichous flagella. The was originally described in 1960, but subsequent molecular analyses have refined its boundaries through genome-based . The genus shares close phylogenetic relationships with other prominent genera in the Enterobacteriaceae family, including , , and , based on shared 16S rRNA gene sequences and core genomic features. Enterobacter species are included in the ESKAPE group of pathogens—encompassing , , , , , and Enterobacter—due to their clinical significance and propensity for multidrug resistance. These relations highlight a common evolutionary lineage within the , where facilitates adaptation across environmental and host niches. Genomic studies reveal that Enterobacter species typically possess chromosomes of 4.5–5.5 Mb in size, with G+C content around 55%, enabling robust 16S rRNA-based identification, though this method struggles with closely related strains. The genus exhibits polyphyletic traits, prompting reclassifications such as the 2017 transfer of Enterobacter aerogenes to based on high genomic similarity to . Evolutionary adaptations, including the acquisition of genes through transfer from plasmids and environmental reservoirs, underscore the genus's dynamic phylogeny and opportunistic nature. A 2019 taxonomic update, informed by (MLST) of housekeeping genes like hsp60, subdivided Enterobacter into distinct clades, recognizing at least 22 species and emphasizing the E. cloacae complex with 13 clusters among its seven core species. This framework has improved species delineation and revealed ongoing , with MLST identifying high-risk clones adapted via mobile elements. Such insights continue to evolve with whole-genome sequencing, reinforcing the genus's position as a polyphyletic assemblage within .

Recognized Species

The genus Enterobacter encompasses approximately 28 validly published species as of 2025, distinguished primarily through genomic sequencing and biochemical profiles, such as urease positivity in E. cloacae. Among these, the core species include Enterobacter cloacae, the and most clinically significant; Enterobacter asburiae, noted for its presence in clinical and environmental samples; and Enterobacter hormaechei, a frequent isolate in hospital-associated cases. Historically, Enterobacter aerogenes was a key in the genus but was reclassified as Klebsiella aerogenes in 2017 based on phylogenetic analysis. Emerging species highlight the genus's expanding diversity, including Enterobacter bugandensis, a multidrug-resistant strain isolated from hospital environments and even the , posing risks in immunocompromised patients. Enterobacter cancerogenus, often plant-associated and capable of producing enzymes for environmental adaptation, occasionally causes opportunistic human infections. Recent discoveries in the 2020s, such as Enterobacter huaxiensis and Enterobacter chuandaensis isolated from human blood in and exhibiting resistance, underscore the genus's evolving clinical threats. Post-2019 additions, including species like Enterobacter chinensis and Enterobacter rongchengensis from clinical samples in , as well as isolates from linked to environmental pollution sources, reflect ongoing taxonomic revisions driven by whole-genome sequencing. The E. cloacae complex, encompassing E. cloacae, E. hormaechei, and related taxa, accounts for 65–75% of Enterobacter infections in clinical settings, with extensive genomic diversity evidenced by over 100 (MLST) types that facilitate and spread. These are often differentiated by subtle biochemical traits, such as and patterns, aiding in clinical diagnostics. Phylogenetic analyses group them into clades that inform evolutionary relationships within the family.

Morphology and Physiology

Cellular Structure

Enterobacter species exhibit a rod-shaped morphology, with cells typically measuring 0.6–1.0 μm in width and 1.2–3.0 μm in length, occurring singly or in pairs under standard growth conditions. This compact, elongated form facilitates their adaptation to diverse environments within the family. As , Enterobacter possess a distinctive that defines their structural integrity and interaction with the external milieu. The outermost layer is the outer membrane, which incorporates (LPS) molecules serving as endotoxins, providing a permeability barrier and contributing to surface properties. Beneath this lies a thin layer in the periplasmic space, offering limited mechanical support compared to Gram-positive counterparts, while the inner cytoplasmic membrane regulates nutrient transport and energy generation. Motility in Enterobacter is achieved through peritrichous flagella, distributed around the cell surface, enabling efficient swimming in liquid media and aiding in colonization of host or environmental niches. Certain strains, notably Enterobacter cloacae, produce a polysaccharide-based capsule enveloping the cell, which enhances resistance to desiccation and phagocytosis by forming a protective glycocalyx. Enterobacter are capable of forming biofilms on abiotic and surfaces, structured by an primarily composed of and proteins that embed bacterial cells, promoting , nutrient retention, and community stability. Unlike some related genera, Enterobacter do not form endospores, relying instead on their facultative nature and fermentative metabolic capabilities for survival under varying oxygen conditions.

Biochemical Characteristics

Enterobacter species are facultative anaerobes that ferment glucose, producing both acid and gas as end products of metabolism. They are also typically -positive, fermenting to produce acid and gas at temperatures of 35–37°C, which aids in their identification on differential media such as . Standard biochemical tests reveal that Enterobacter is oxidase-negative and catalase-positive, consistent with its membership in the family. Most species are indole-negative, though exceptions exist in some strains. The classic IMViC pattern for Enterobacter is --++, characterized by a negative test (indicating no mixed acid fermentation under the test conditions), a positive Voges-Proskauer test (detecting production), and a positive citrate utilization test (using as the sole carbon source). activity is variable across species, with typically positive and others, such as Enterobacter ludwigii, negative; (H₂S) production is consistently negative on triple sugar iron agar. Enterobacter exhibits optimal growth at 37°C, the , within a pH range of 6–8, and demonstrates tolerance to concentrations up to 4–10%, enabling survival in moderately saline environments. The genus inherently produces β-lactamases, including chromosomally encoded AmpC cephalosporinases, which confer resistance to certain β-lactam antibiotics and are a key enzymatic feature. Ornithine decarboxylase activity is positive in most species, facilitating the breakdown of to , , and . Differentiation from relies on several traits: Enterobacter species often lack decarboxylase activity (negative in most, unlike the positive result in E. coli) and show no delayed fermentation, producing acid and gas promptly without the characteristic slow onset sometimes observed in other enterics. Cellular , typically peritrichous flagella-mediated, supports the performance of these biochemical assays by allowing even distribution in liquid media.
Biochemical TestTypical Result for Enterobacter
OxidaseNegative
CatalasePositive
IndoleNegative (most species)
Methyl RedNegative
Voges-ProskauerPositive
CitratePositive
UreaseVariable (e.g., + in E. cloacae)
H₂S ProductionNegative
Ornithine DecarboxylasePositive
Lysine DecarboxylaseNegative (most species)
β-Lactamase ProductionPositive (inherent)

Ecology and Habitat

Natural Environments

Enterobacter species are ubiquitous environmental bacteria, commonly inhabiting soil, freshwater, sewage, and decaying vegetation. They thrive in diverse terrestrial and aquatic ecosystems, where they contribute to nutrient cycling and decomposition processes. For instance, species such as Enterobacter cloacae and E. amnigenus have been isolated from wild soils and surface waters, reflecting their adaptability to natural substrates rich in organic matter. In plant-associated environments, Enterobacter forms part of the rhizosphere microbiome, acting as endophytic bacteria that promote plant growth through nitrogen fixation and pathogen suppression, as demonstrated by E. cloacae strains enhancing legume rhizosphere communities. These bacteria also maintain commensal associations with s and animals, particularly in the , oral cavity, and . In the human gut, Enterobacter species, including E. cloacae, are present as part of the at low densities, typically less than 10^8 CFU/g in healthy adults, though they constitute a minor fraction (often <1%) of the total . In the oral cavity, colonization rates can reach 18.7% among certain populations, with species like E. gergoviae and E. aerogenes detected in and . On surfaces, they occur transiently as part of the transient , facilitated by environmental exposure. In industrial settings, Enterobacter frequently appears as a contaminant in , , and water distribution systems. During food production, it contaminates and products via or contact, posing risks in ready-to-eat items. In pharmaceutical facilities, it persists in systems, where biofilms elevate levels and bacterial counts. Water systems, including those in hospitals, harbor Enterobacter, with detections in up to 41.5% of samples near sinks and showers, underscoring its role in environmental reservoirs. Enterobacter demonstrates remarkable adaptability, surviving in oligotrophic environments with limited nutrients and forming on pipes and abiotic surfaces to enhance persistence. This biofilm capability, observed in like E. aerogenes, allows of distribution networks under low-nutrient conditions, resisting disinfection. Its global distribution is widespread, with higher prevalence in tropical regions due to favorable warm, moist conditions that support proliferation in freshwater and . Recent studies highlight E. bugandensis strains isolated from the , which exhibit genomic adaptations for resilience to microgravity and cosmic radiation, including enhanced and metabolic shifts that confer multidrug resistance.

Factors Influencing Distribution

The distribution and prevalence of Enterobacter species are significantly influenced by , with optimal occurring between 25°C and 40°C, allowing proliferation in warm environments such as and bodies. These exhibit mesophilic characteristics, with strains demonstrating peak metabolic activity around 37–43°C, though viability declines sharply above 50°C due to on cellular components. In colder conditions, Enterobacter can survive at -20°C in matrices, where low temperatures induce rather than active , contributing to long-term in temperate regions. pH and further modulate Enterobacter's , with thriving populations observed at neutral levels of 6–8, which support enzymatic functions essential for . Many strains are halotolerant, enduring up to 7% NaCl through osmotic adjustment mechanisms, enabling adaptation to brackish waters and saline soils without substantial growth inhibition. Beyond these tolerances, extreme shifts below 5 or above 10, or salinities exceeding 7%, restrict distribution by disrupting integrity and . Nutrient availability plays a critical role in Enterobacter's spread, as the genus prefers organic-rich media where carbon sources like glucose fuel rapid replication. Certain strains, such as Enterobacter cloacae, possess nitrogen-fixing capabilities via nif genes, facilitating symbiosis with plants in nutrient-poor soils and enhancing colonization in agricultural ecosystems. This trait allows Enterobacter to access atmospheric nitrogen, promoting its persistence in oligotrophic environments where other competitors falter. Human activities profoundly alter Enterobacter distribution, particularly through in systems, where elevated levels select for resistant strains, increasing densities in contaminated rivers and lakes. processes reduce Enterobacter populations by up to 99% via disinfection and filtration, yet residual cells and genes persist in effluents, facilitating downstream dissemination. and agricultural effluents thus amplify prevalence in anthropogenically modified habitats. Climatic conditions drive higher Enterobacter densities in warm, humid areas, where elevated temperatures and enhance and stability, favoring proliferation in tropical and subtropical zones. exacerbates this by potentially expanding habitable ranges, as rising temperatures accelerate growth rates and resistance evolution in environmental reservoirs. Biological interactions, including , bolster Enterobacter's distribution by coordinating formation, which shields communities from and antimicrobials in diverse habitats. Conversely, predation by , such as amoebae and , limits populations by grazing free-living cells, thereby regulating densities and preventing unchecked expansion in natural microbial consortia.

Pathogenesis

Virulence Factors

Enterobacter species possess several key factors that contribute to their ability to colonize host tissues, evade immune responses, and establish infections. The capsule, often referred to as the K-antigen, forms a protective layer around the bacterial cell that inhibits by host immune cells such as neutrophils and macrophages by preventing complement deposition and opsonization. This capsule is present in many clinical isolates of Enterobacter, including E. hormaechei, where it confers serum resistance and enhances in models of . Flagella and fimbriae play critical roles in , , and initial host cell interaction. Flagella, which are peritrichously arranged in Enterobacter species, enable and facilitate early stages of formation on host surfaces. Type 1 fimbriae, encoded by the fim including fimH, mediate to mannose-containing receptors on epithelial cells, promoting . Type 3 fimbriae, encoded by genes such as mrkABCDF and mrkD, further enhance adherence to host components and abiotic surfaces like catheters, contributing to persistent infections. These structures are widespread across Enterobacter species, such as E. aerogenes (now often classified as ), where they support initiation and invasion. The (LPS) component of the outer membrane serves as a potent endotoxin in Enterobacter, triggering inflammatory responses through activation of the (TLR4) on host immune cells, leading to release and . Modifications to LPS, such as those conferring resistance to like polymyxin, are more prevalent in clinical isolates of E. cloacae (approximately 4.2%) compared to other enterobacteria, enhancing bacterial survival in host environments. Secretion systems enable direct manipulation of cells. The (T3SS), present in about 27% of clinical E. cloacae isolates, injects effector proteins into cells to disrupt cytoskeletal functions and promote bacterial uptake or . The type VI secretion system (T6SS), identified in species like E. mori with up to 66 associated genes, delivers antibacterial effectors to compete with and supports virulence during infection. Additionally, siderophores such as enterobactin, encoded by the entB gene in E. aerogenes, facilitate iron acquisition from iron-binding proteins like , which is essential for bacterial growth and persistence in iron-limited tissues. Biofilm formation represents a major strategy, allowing Enterobacter to form multidrug-tolerant communities on indwelling devices such as catheters. This process is regulated by mechanisms, including the luxS , which produces autoinducer-2 (AI-2) signals to coordinate community behavior. Genes like csgBA, part of the curli fimbriae , are detected in 78% of clinical E. cloacae isolates and promote fiber production essential for matrix stability. These shield from antibiotics and host defenses, exacerbating nosocomial infections. Enzymatic virulence factors further aid tissue invasion and survival. Hemolysins, secreted by Enterobacter species including E. cloacae, lyse host red blood cells and exhibit cytotoxic effects on other cell types, facilitating nutrient release and dissemination. Proteases contribute to host tissue degradation, enhancing bacterial spread during infection. Intrinsic β-lactamases, such as AmpC, are universally present across Enterobacter species and provide baseline resistance to β-lactam antibiotics, while acquired extended-spectrum β-lactamases (e.g., TEM, SHV, CTX-M) in clinical isolates amplify this resistance, complicating treatment.

Infection Mechanisms

Enterobacter species primarily act as opportunistic pathogens, entering the host through breaches in the skin or mucosal barriers, or via contaminated medical devices such as catheters and ventilators, particularly in healthcare settings. The low infectious dose, estimated at 10^3 to 10^5 colony-forming units (CFU), facilitates establishment in vulnerable individuals, allowing the to colonize sites like the urinary tract or with minimal initial exposure. Adhesion to host epithelial cells is mediated by fimbriae, including type 1 fimbriae (via FimH adhesin) and type 3 fimbriae (via MrkD), which bind residues and promote close contact for . Once attached, Enterobacter can invade host cells and survive intracellularly within macrophages by modulating (LPS) structure to reduce immune recognition. These processes enable the bacteria to transition from surface to deeper penetration. Immune evasion is achieved through the polysaccharide capsule, which inhibits complement activation and opsonophagocytosis by masking bacterial surface antigens, and via formation that shields cells from antibodies and . The capsule, particularly in species like E. hormaechei, is essential for resisting serum-mediated killing. Additionally, Enterobacter produces toxins such as LPS, which acts as an endotoxin to trigger inflammatory cascades leading to , and hemolysins that lyse red blood cells, contributing to tissue damage. Spread occurs through hematogenous dissemination, often initiated by bacterial translocation from the gut in immunocompromised hosts, allowing systemic . , involving signals like N-acyl homoserine lactones, coordinates expression of genes to enhance collective behaviors such as maturation and release during . Host predisposition plays a critical role, with infections disproportionately affecting neonates, the elderly, and mechanically ventilated patients; approximately 90% of cases are nosocomial, linked to prolonged hospitalization and invasive procedures.

Clinical Aspects

Associated Infections and Diseases

Enterobacter species are primarily associated with nosocomial infections. As of 2006-2007, they accounted for approximately 5% of healthcare-associated infections . According to data from 1976-1989 and 1993-2004, these ranked as the eighth most common overall cause of hospital-acquired infections and the fourth among gram-negative , representing 13.5% of gram-negative isolates in intensive care units (ICUs) and ranking as the fifth most frequent isolated from infections; more recent suggests possible declines in these proportions. Bacteremia caused by Enterobacter is a significant nosocomial concern, comprising 4.7% of monomicrobial in ICUs and 3.1% in non-ICU wards, according to the SCOPE project (1995-2002). The crude mortality rate for Enterobacter bacteremia ranges from 20% to 46%, with attributable mortality estimated at 6-40%; resistance to cephalosporins increases mortality to 33.7% compared to 18.6% for susceptible strains. is another key infection, with Enterobacter accounting for 11.2% of ICU cases (data from 1980s-1990s). Urinary tract infections (UTIs) due to Enterobacter are common in healthcare settings, particularly those related to indwelling catheters, and, as of 1976-1989, ranked as the fifth most frequent cause among UTIs in ICUs; contemporary data may reflect shifts in rankings. These infections are prevalent in facilities, where prolonged catheterization increases risk. Wound and skin infections, including post-surgical site infections and abscesses, are frequently linked to Enterobacter, especially in burn units or after surgical procedures; as of 1976-1989, the species ranked fourth among causes of surgical infections in ICUs. Other notable infections include , prosthetic valve , and occasional gastrointestinal outbreaks from foodborne sources. carries a 44.4% . Epidemiologically, as of the , bacteremia occurred at a rate of about 1.25 cases per 1,000 admissions, with higher incidences in ICUs. A global rise in , including spp., has been observed post-2020, attributed in part to increased during the . At-risk populations include immunocompromised individuals, such as cancer patients and those with , as well as patients with invasive devices or prolonged exposure; community-acquired cases remain rare. Most clinical infections are caused by species within the complex. factors like formation contribute to persistence in these high-risk clinical sites.

Symptoms and Presentation

Enterobacter infections typically present with a range of clinical that vary depending on the site of and the patient's underlying health status, often manifesting as opportunistic infections in hospitalized or immunocompromised individuals. Common systemic features include fever exceeding 38°C, chills, and with counts greater than 12,000/μL, alongside elevated levels as markers of . In cases of bacterial translocation from the , patients may experience alongside systemic symptoms. Severity ranges from mild, self-limited presentations in immunocompetent hosts to , life-threatening illness in neonates and immunocompromised patients. Bacteremia and sepsis due to Enterobacter species commonly feature high fever above 38°C in over 80% of cases, accompanied by chills, , and hemodynamic instability. (SIRS) develops in approximately 50% of affected patients, potentially progressing to in up to 33% and contributing to high mortality rates. These presentations are frequently observed in nosocomial settings, with and elevated inflammatory markers further supporting the . Pneumonia caused by Enterobacter, often ventilator-associated, presents with , dyspnea, and production of purulent , alongside high fever and . Patients may exhibit , , and crackling sounds on auscultation, with chest revealing infiltrates or consolidations indicative of lower involvement. This is particularly severe in elderly or mechanically ventilated individuals, where systemic symptoms like and elevated white blood cell counts predominate. Urinary tract infections (UTIs) from Enterobacter typically manifest as , urinary frequency, urgency, and flank pain, though up to 30% of cases in elderly patients may be asymptomatic without overt symptoms. and systemic signs such as fever can occur, especially in catheterized or institutionalized older adults, where greater than 12,000/μL is common. These infections often remain localized but can lead to ascending involvement in vulnerable populations. Wound and soft tissue infections present with localized , swelling, warmth, and drainage at the site, potentially progressing to with severe pain and edema. In more advanced cases, particularly in immunocompromised hosts, the infection may extend to , accompanied by fever and regional . Elevated and are typical laboratory correlates, highlighting the inflammatory response. In neonates, Enterobacter infections such as often result in fulminant disease with , bulging , fever or , poor feeding, and seizures, differing markedly from milder presentations in immunocompetent adults. These symptoms reflect the pathogen's propensity for central nervous system invasion in this population, with high rates of systemic inflammatory response and potential for rapid deterioration.

Diagnosis

Diagnosis of Enterobacter infections relies primarily on microbiological confirmation through specimen collection and laboratory analysis, as clinical presentation alone is nonspecific. Appropriate specimens include , , , and swabs, depending on the suspected site of . For suspected bacteremia, cultures remain the gold standard, with recommendations for at least two sets ( and ) to improve yield and reduce rates. In cases of urinary tract infections, specimens are collected via midstream clean-catch or catheterization, followed by culture. and swabs are obtained for respiratory or infections, respectively, ensuring sterile technique to avoid contaminants. Overall positivity rates for cultures in Enterobacter bacteremia vary but are reported in approximately 40-60% of clinically suspected cases, influenced by timing and prior exposure. Once collected, specimens undergo culture on selective media for isolation and preliminary identification. Enterobacter species grow well on , appearing as pink lactose-fermenting colonies due to their ability to ferment . Further identification employs automated biochemical systems such as API 20E strips or VITEK 2, which profile enzymatic reactions like citrate utilization, production, and to distinguish Enterobacter from similar ; these systems achieve identification accuracy exceeding 90% for the genus. Gram of specimens reveals gram-negative rods, providing rapid presumptive evidence. Molecular methods offer faster and more precise identification, particularly in complex cases. (PCR) targeting 16S rRNA genes or species-specific sequences, such as those for , enables direct detection from clinical samples without culture. time-of-flight mass spectrometry (MALDI-TOF MS) provides rapid species-level identification from cultured isolates, with reported accuracy rates of about 95% for Enterobacter genus and complex members. These techniques are especially valuable in , where timely identification can guide therapy. Serological tests for Enterobacter infections are limited and not routinely used in , as antibody responses are unreliable for acute . However, capsular detection assays exist for specific like E. cloacae, targeting K antigens in or , though their remain suboptimal compared to culture-based methods. supports by localizing infection sites but does not confirm . Chest X-rays are standard for suspected , revealing infiltrates or consolidation consistent with bacterial . Computed tomography (CT) or (MRI) is employed for detecting abscesses in intra-abdominal or infections, guiding procedures. Key challenges in diagnosing Enterobacter infections include differentiation from morphologically and biochemically similar genera like , which requires motility testing (Enterobacter is motile, Klebsiella non-motile) or advanced molecular assays. Additionally, rising resistance complicates interpretation. In 2025, syndromic molecular panels, such as multiplex PCR-based systems for , enable faster detection of Enterobacter in or positive cultures, reducing time to identification from days to hours and improving outcomes in critical care.

Treatment and Management

Treatment of Enterobacter infections primarily involves antimicrobial therapy tailored to the site of infection, severity, and susceptibility patterns, with empirical regimens selected to cover potential AmpC β-lactamase production inherent to many Enterobacter species. For severe cases such as bacteremia or , empirical therapy often includes like imipenem or , or fourth-generation cephalosporins such as cefepime, due to their stability against AmpC enzymes; third-generation cephalosporins like ceftazidime may be used cautiously but risk resistance emergence. Treatment duration typically ranges from 7 to 14 days, depending on clinical response and source control achievement. Once is confirmed through testing, can be de-escalated to narrower agents. Aminoglycosides such as are often added for synergistic effect in serious infections like or , while fluoroquinolones like are suitable for susceptible urinary tract infections or mild cases. The Infectious Diseases Society of America (IDSA) guidelines recommend as first-line for extended-spectrum β-lactamase (ESBL)-producing outside the urinary tract, and cefepime for AmpC-producers in non-urinary infections, with to oral options like trimethoprim-sulfamethoxazole or fluoroquinolones if susceptibility allows. Supportive care is essential, including fluid resuscitation, vasopressors for , and source control measures such as removal of infected catheters or surgical drainage of abscesses to improve outcomes. Prevention strategies emphasize control to curb nosocomial transmission. Core measures include rigorous hand , adherence to device insertion and maintenance protocols, and to limit overuse that promotes resistance. Emerging evidence suggests may reduce gut translocation of in high-risk patients, potentially lowering risk by modulating . With appropriate , cure rates for Enterobacter infections reach 70-90%, though bacteremia carries higher mortality of 20-40%, influenced by patient comorbidities and timely . Resistance patterns, such as AmpC hyperproduction, necessitate prompt susceptibility-guided adjustments to avoid treatment failure.

Antibiotic Resistance

Enterobacter species exhibit intrinsic resistance to several antibiotics, primarily mediated by chromosomal AmpC β-lactamase, which hydrolyzes penicillins and cephalosporins, including early-generation cephalosporins like . This enzyme is constitutively expressed at low levels but can be derepressed under selective pressure, conferring resistance to β-lactams without the need for acquisition. Additionally, low-level resistance to fluoroquinolones arises from intrinsic efflux pumps, such as those in the resistance-nodulation-division family, which actively export these agents from the cell. Acquired resistance in Enterobacter is largely plasmid-mediated, enabling rapid dissemination of resistance genes. Extended-spectrum β-lactamases (ESBLs), such as CTX-M variants, hydrolyze third- and fourth-generation cephalosporins, while carbapenemases like KPC and NDM confer to by hydrolyzing their β-lactam ring. These mechanisms contribute to multidrug-resistant (MDR) isolates, with prevalence ranging from 20% to 42% in clinical settings, particularly among hospital-acquired strains. Epidemiologically, Enterobacter demonstrates high resistance to third-generation cephalosporins in environments, with rates approaching 50% in some studies due to AmpC derepression and ESBL production. Colistin resistance is emerging, driven by plasmid-borne mcr genes, with reported rates of 5-10% in select populations by 2025, complicating last-resort treatment options. Beyond enzymatic mechanisms, Enterobacter employs structural adaptations for resistance. Biofilms provide a protective matrix that limits penetration and promotes persister cells, enhancing tolerance to multiple drugs. Loss or downregulation of outer membrane porins, such as OmpC and OmpF, reduces β-lactam entry into the , synergizing with β-lactamases. Integrons, , facilitate the clustering and horizontal transfer of genes, including those for aminoglycosides and trimethoprim. Globally, , including Enterobacter, are designated as critical priority pathogens by the due to their high burden in healthcare settings. Post-2020, resistance patterns have intensified, mirroring rises in carbapenem-resistant (CRAB) with increases in hospital-onset infections exceeding 70% in some regions, attributed to disrupted infection control during the . Genomic surveillance using (MLST) has revealed clonal expansions, such as ST171 in E. cloacae, driving the spread of carbapenemase genes. Antibiotic stewardship programs mitigate by optimizing prescribing practices, achieving reductions of 15-20% in MDR Enterobacter isolates through decreased broad-spectrum use and prospective audits. These interventions necessitate adjustments in treatment for resistant strains, favoring combination therapies like with β-lactamase inhibitors.

Additional Associations

Research has linked certain species within the genus Enterobacter, particularly Enterobacter cloacae, to obesity through alterations in the gut microbiome. A seminal 2012 study isolated E. cloacae strain B29 from the jejunum of a morbidly obese individual (BMI 58.8 kg/m²), where it dominated the fecal microbiota at approximately 35% relative abundance. The underlying mechanism centers on lipopolysaccharide (LPS) endotoxins produced by E. cloacae, which trigger low-grade chronic inflammation. This inflammation activates Toll-like receptor 4 (TLR4) pathways in adipose tissue, leading to metabolic endotoxemia and promotion of fat mass expansion. In experimental models, germ-free mice monoassociated with E. cloacae B29 and fed a high-fat diet developed obesity and insulin resistance, with body weights comparable to those of conventional mice on the same diet; antibiotic administration reversed this obesity phenotype. Human evidence supports a potential role for Enterobacter in persistence. In the index patient from the 2012 study, a 30.1 kg (17% of initial body weight) after 9 weeks on a fermented-food diet reduced E. cloacae abundance from 35% to 1.8%; after 23 weeks and 51.4 kg total loss, it became undetectable, aligning with improved metabolic parameters. Recent metagenomic analyses continue to associate elevated Enterobacter genus abundance with features, including and , in obese populations. Emerging probiotic interventions, such as Lactobacillus plantarum strains, have demonstrated efficacy in reducing and in high-fat diet-induced models in mice, hinting at therapeutic potential. Nonetheless, the causative contribution of Enterobacter to is debated, as the disorder is multifactorial, influenced by diet, host genetics, and broader .

Biotechnological and Environmental Roles

Enterobacter species play significant roles in due to their metabolic versatility in degrading environmental pollutants. For instance, strains have demonstrated the ability to degrade crude oil, achieving up to 70% removal after 30 days of incubation in contaminated , as confirmed by GC-MS analysis showing breakdown of hydrocarbons into simpler compounds. Similarly, E. cloacae subsp. strains isolated from oil-contaminated sites can biodegrade hydrocarbons through cell uptake mechanisms, contributing to restoration efforts. In remediation, Enterobacter sp. SL effectively reduces (Cr(VI)) using waste as a carbon source in reactors, with complete reduction of 100 mg/L Cr(VI) observed within 16 hours. Enterobacter kobei FACU6 removes up to 83.4% of lead from contaminated media, highlighting its potential for treating industrial wastewater laden with toxic metals. Additionally, strains like Enterobacter chengduensis G2.8 degrade pesticides such as and its metabolites, achieving 96% removal of fipronil in over 14 days. In agriculture, certain Enterobacter strains act as plant growth-promoting rhizobacteria (PGPR) through and solubilization, serving as effective biofertilizers. Enterobacter cloacae PNE2 fixes atmospheric nitrogen and solubilizes s and potassium, enhancing availability in and promoting and in crops like and . Inoculation with Enterobacter sp. R4-368 increases yield in by improving growth parameters, while E. cloacae Rs-2 replaces up to 50% of chemical fertilizers, boosting content and by 20-30% in trials. These mechanisms, including production of (IAA) and 1-aminocyclopropane-1-carboxylate () deaminase, reduce plant stress and enhance yields without relying solely on synthetic inputs. Industrially, Enterobacter species contribute to biofuel production via fermentation processes. Enterobacter hormaechei RF2 ferments fruit waste to produce with yields of approximately 0.4 g/g , demonstrating tolerance to high concentrations and genetic stability for scalable applications. Strains like E. cloacae IP8 produce thermostable cellulases from plant leaf litter, aiding in the hydrolysis of for generation, with optimized mutants achieving higher enzyme activity under industrial conditions. In research, Enterobacter serves as a model for studying quorum sensing (QS) due to its acyl-homoserine lactone (AHL)-based communication systems, which regulate biofilm formation and gene expression in bacterial communities. Certain strains also show probiotic potential; commensal Enterobacteriaceae compete with pathogens like Salmonella enterica serovar Enteritidis for oxygen in the gut, reducing colonization by over 90% in mouse models and preventing organ invasion. Environmentally, Enterobacter aids through , converting nitrates to gas under aerobic conditions. Enterobacter hormaechei N5 achieves 98.7% efficiency at a C/N ratio of 3.0 using sodium succinate as a carbon source, outperforming methanol-based systems in treating nitrate-polluted effluents. Recent advancements include 2024 patents utilizing Enterobacter asburiae in plastic-degrading solutions, where it breaks down alongside other s in consortiums. E. cloacae AKS7 enhances () biodegradation in soil via , reducing weight by promoting microbial . Safety considerations in these applications emphasize selecting non-pathogenic strains, as Enterobacter species exhibit variable ; environmental isolates like E. kobei DH7 are screened for low pathogenicity before deployment, minimizing risks to immunocompromised individuals in agricultural or settings.

References

  1. [1]
    Enterobacter Infections - StatPearls - NCBI Bookshelf
    Jun 26, 2023 · Enterobacter is a genus of gram-negative, rod-shaped, facultatively anaerobic bacteria of the Enterobacteriaceae family. It is also described as ...
  2. [2]
    Enterobacter spp.: Update on Taxonomy, Clinical Aspects, and ...
    The genus Enterobacter is a member of the ESKAPE group, which contains the major resistant bacterial pathogens.
  3. [3]
    Enterobacter aerogenes and Enterobacter cloacae - Frontiers
    Enterobacter is a genus of a common Gram-negative, facultative anaerobic, rod-shaped, non-spore-forming bacteria belonging to the family Enterobacteriaceae.
  4. [4]
    Enterobacter Infections - Medscape Reference
    Oct 3, 2024 · Enterobacter infections can include bacteremia, lower respiratory tract infections, skin and soft tissue infections, urinary tract infections (UTIs), ...Practice Essentials · Background · Pathophysiology · Epidemiology<|control11|><|separator|>
  5. [5]
    Clinical Impact of Enterobacter cloacae Complex - Medscape
    cloacae accounts for up to 5% of hospital-acquired sepsis, 5% of nosocomial pneumonias, 4% of nosocomial urinary tract infections and 10% of postsurgical ...
  6. [6]
    Multi-drug resistant Enterobacter bugandensis species isolated from ...
    Nov 23, 2018 · Five Enterobacter bugandensis strains isolated from the International Space Station (ISS) were carried out and compared with genomes of three clinical strains.
  7. [7]
    Species: Bacterium cloacae - LPSN
    Name: "Bacterium cloacae" (Jordan 1890) Lehmann and Neumann 1896. Category: Species. Proposed as: comb. nov. Basonym: "Bacillus cloacae" Jordan 1890.
  8. [8]
    Enterobacter aerogenes Hormaeche and Edwards 1960 ... - PubMed
    Enterobacter aerogenes Hormaeche and Edwards 1960 (Approved Lists 1980) and Klebsiella mobilis Bascomb et al. 1971 (Approved Lists 1980) were placed on the ...Missing: Aerobacter | Show results with:Aerobacter
  9. [9]
    Enterobacter Hormaechei - an overview | ScienceDirect Topics
    The genus Enterobacter was first proposed by Hormaeche and Edwards in 1960 when the motile and ornithine decarboxylase (ODC) positive members of the genus ...
  10. [10]
    proposal for Enterobacterales ord. nov. divided into the families ...
    Proposal for Enterobacterales ord. nov. divided into the families Enterobacteriaceae, Erwiniaceae fam. nov., Pectobacteriaceae fam. nov., Yersiniaceae fam. nov.Missing: renamed | Show results with:renamed
  11. [11]
    An opportunistic pathogen isolated from the gut of an obese human ...
    Dec 13, 2012 · Here we show that one endotoxin-producing bacterium isolated from a morbidly obese human's gut induced obesity and insulin resistance in germfree mice.
  12. [12]
    The Epidemiology of Carbapenem-Resistant Enterobacteriaceae
    By the late 1990s to early 2000s, there were several reports of VIM-type MBLs in Enterobacteriaceae [13]. Currently, VIM-2 is the most common VIM-type MBL ...
  13. [13]
    Genus: Enterobacter - LPSN
    Genome-based phylogeny and taxonomy of the 'Enterobacteriales': proposal for Enterobacterales ord. nov. divided into the families Enterobacteriaceae, ...
  14. [14]
  15. [15]
    Enterobacter spp.: Update on Taxonomy, Clinical Aspects, and ...
    Jul 17, 2019 · The genus Enterobacter includes facultative anaerobic Gram-negative bacilli that are 2 mm long, are motile by means of peritrichous flagella ...
  16. [16]
  17. [17]
  18. [18]
    Complete Genome Sequence of Enterobacter roggenkampii ED5, a ...
    Hence, this strain was further selected for comprehensive genome analysis, which includes a genome size of 4,702,851 bp and 56.05% of the average G + C content.
  19. [19]
  20. [20]
  21. [21]
    Genome Sequence of Enterobacter cancerogenus YZ1
    Enterobacter cancerogenus is usually known as an opportunistic human pathogen. Recently, it has attracted great attention for its capability to produce ...<|control11|><|separator|>
  22. [22]
    Enterobacter huaxiensis sp. nov. and Enterobacter chuandaensis sp ...
    Enterobacter strains 090008 T and 090028 T were recovered from the blood of two different patients at West China Hospital, Chengdu, PR China in 2017.
  23. [23]
    Enterobacter cloacae, an Endophyte That Establishes a Nutrient ...
    May 7, 2019 · The scanning electronic microscopy for E. cloacae showed a straight rod-like morphology with cells 0.6–1.0 μm wide X 1.2–3.0 μm long. Cells are ...
  24. [24]
    Enterobacter - an overview | ScienceDirect Topics
    Generally, these bacteria are 0.6–1.0 × 2–3 μm in size. Enterobacter species produce round, iridescent, flat, nonpigmented, irregular-edged colonies, when grown ...
  25. [25]
    Enterobacteriaceae - an overview | ScienceDirect Topics
    The Enterobacteriaceae are Gram-negative rod-shaped bacteria which are typically motile by virtue of peritrichous flagella, are non-sporing, facultative ...
  26. [26]
    Structures of Gram-Negative Cell Walls and Their Derived ... - NIH
    Together the plasma membrane and the cell wall (outer membrane, peptidoglycan layer, and periplasm) constitute the gram-negative envelope (5, 9). Our entire ...
  27. [27]
    Enterobacteriaceae: Characteristics, Identification - Microbe Notes
    Aug 7, 2025 · Enterobacteriaceae is a family of Gram-negative rod-shaped (bacilli) bacteria in the order Enterobacterales of the class Gammaproteobacteria ...
  28. [28]
    Capsular Polysaccharide Is Essential for the Virulence of the ...
    Feb 13, 2023 · The ECC is composed of at least seven species, of which Enterobacter cloacae and Enterobacter hormaechei are the most clinically relevant ECC ...
  29. [29]
    Insights Into the Dynamics and Composition of Biofilm Formed ... - NIH
    Jul 5, 2022 · EPS are primarily composed of polysaccharides, protein, lipids, humic-like substances, extracellular DNA, and water channels (Jefferson, 2004).
  30. [30]
    Escherichia, Klebsiella, Enterobacter, Serratia, Citrobacter ... - NCBI
    All genera except Klebsiella are flagellated. Some strains produce capsules. Virulence often depends on the presence of attachment pili (which can be ...
  31. [31]
    Enterobacter - an overview | ScienceDirect Topics
    Enterobacter usually have a negative methyl-red test, a positive Voges-Proskauer test, can use citrate as a carbon source, can grow in Moller's KCN medium at ...
  32. [32]
    Tests used to identify Gram Negative Bacteria
    This is a test commonly used when trying to identify Gram-negative enteric bacteria, all of which are glucose fermenters but only some of which produce gas.
  33. [33]
    Biochemical Test and Identification of Enterobacter cloacae
    Nov 11, 2024 · Biochemical Test and Identification of Enterobacter cloacae ; Spore, Negative (-ve) ; Urease, Positive (+ve) ; VP (Voges Proskauer), Positive (+ve).
  34. [34]
    Salt-tolerant endophytic bacterium Enterobacter ludwigii B30 ...
    Aug 1, 2022 · Enterobacter ludwigii can survive at 15–42°C and pH 5–10 (Hoffmann et al., 2005). Khan et al. (2020) found that E.
  35. [35]
    AmpC β-lactamase-producing Enterobacterales: what a ... - PubMed
    Mar 6, 2019 · The objective of this paper is to review the epidemiological impact, diagnostic issues and treatment options with AmpC producers.
  36. [36]
    Biochemical Test of Enterobacter aerogenes - Microbe Notes
    Apr 18, 2022 · Biochemical Test of Enterobacter aerogenes ; Urease, Negative (-ve) ; VP (Voges Proskauer), Positive (+ve) ; Fermentation of ; Arabinose, Positive ...
  37. [37]
    Gut inflammation can boost horizontal gene transfer between ...
    However, in the normal gut, the Enterobacteriaceae are generally present in very low densities (<<108 cfu/g). These densities are way too low for efficient ...
  38. [38]
    Enterobacteriaceae in the Human Gut: Dynamics and Ecological ...
    Feb 23, 2024 · However, Enterobacteriaceae usually constitutes less than 1% of the healthy gut microbiota. This family includes a diversity of bacterial genera ...Missing: sewage | Show results with:sewage
  39. [39]
    Enterobacteriaceae ISOLATES FROM THE ORAL CAVITY OF ...
    The aim of this study was to evaluate the presence of Enterobacteriaceae in the oral cavity of workers at an oncology hospital in the Midwest region of Brazil.Missing: commensal skin CFU
  40. [40]
    Foodborne Pathogens of Enterobacteriaceae, Their Detection and ...
    Water is well-known for its importance in the production, processing, and preparation of food. It is also a medium for the transmission of pathogens during food ...3.1 E. Coli · 3.2 Salmonella · 4.2 Polymerase Chain...<|separator|>
  41. [41]
    Identification of bacteria in drinking and purified water during the ...
    This biofilm can spread microorganisms within the system and contribute to an increase in particles, bacteria, and the level of total organic carbon (TOC).
  42. [42]
    Unveiling the hidden threat of carbapenemase-producing ...
    Results showed that carbapenemase-producing Enterobacteriaceae was detected in 41.5% of the samples within 1 m of a water source (showers or sinks), with 20.6% ...Missing: percentage | Show results with:percentage
  43. [43]
    Behavior of Pseudomonas aeruginosa and Enterobacter aerogenes ...
    Nov 9, 2020 · P. aeruginosa is recognized as a good colonizer, able to survive in water and biofilms in poor environmental conditions (e.g., oligotrophy, ...
  44. [44]
    High Rate of Acquisition but Short Duration of Carriage of Multidrug ...
    Multidrug-resistant Enterobacteriaceae (MRE) are widespread in the community, especially in tropical regions. Travelers are at risk of acquiring MRE in these ...
  45. [45]
    Genomic, functional, and metabolic enhancements in multidrug ...
    Mar 23, 2024 · We have carried out a comprehensive study to understand the genomic intricacies of ISS-derived E. bugandensis in comparison to terrestrial strains.
  46. [46]
    The growth profile, thermotolerance and biofilm formation of ...
    Mar 11, 2004 · In IFM the organism grew as low as 6°C and optimally at 37–43°C. In faecal coliform tests, 23% of strains (n = 70) produced gas from lauryl ...
  47. [47]
    Survival Strategies of the Plant-Associated Bacterium Enterobacter ...
    Mar 7, 2016 · In this study, a soilborne Cd-resistant bacterium was isolated and identified as Enterobacter sp. strain EG16. It tolerates high external Cd concentrations.
  48. [48]
    Enterobacter soli Strain AF-22b-4245: Study of the Genome ... - MDPI
    Salt tolerance was determined in a peptone medium with the addition of 1%, 5%, 10%, and 15% NaCl. To accomplish this, 50 µL of bacterial suspension was added to ...
  49. [49]
    Effects of environmental conditions (temperature, pH, and glucose ...
    The results indicated that higher temperatures (25 to 42°C) and pH values (7.0 and 8.0) led to more robust biofilm formation than lower temperatures (4 and 10°C) ...
  50. [50]
    Effects of Enterobacter cloacae HG-1 on the Nitrogen-Fixing ...
    The present study is the first to screen E. cloacae HG-1 with high salt tolerance. We determined that the strain was involved in nitrogen fixation, phosphorus ...
  51. [51]
    The nitrogen-fixing strains of Enterobacter cloacae isolated from ...
    Apr 10, 2025 · Nitrogen fixation is carried out efficiently by Enterobacter, Bradyrhizobium, Frankia, Mesorhizobium, Gluconacetobacter, Rhizobium, and ...
  52. [52]
    Antibiotic Resistance in Enterobacteriaceae from Surface Waters in ...
    From the Brazilian urban lake, 85% of the Enterobacteriaceae (n = 40) cultured were resistant to at least one clinically important antibiotic, including ST131 ...
  53. [53]
    Antimicrobials and Antibiotic Resistance Genes in Water Bodies
    Generally, wastewater treatment regulates the level of bacterial count, but due to differences in treatment plant designs and operations, the fate of ARBs and ...
  54. [54]
    Potential Ecological and Human Health Impacts of Antibiotics and ...
    Nov 28, 2007 · Studies show that municipal wastewater treatment plants (WWTPs) are important point sources of antibiotics and antibiotic-resistant bacteria in the environment.
  55. [55]
    (PDF) The Effects of Ventilation, Humidity, and Temperature on ...
    Oct 13, 2025 · We characterized the role of humidity and ventilation in bacterial growth and genus distribution at different temperatures (26 °C and 34 °C).
  56. [56]
    Climate change and antimicrobial resistance: a global-scale analysis
    Sep 29, 2025 · A growing body of research highlights that temperature fluctuations can accelerate resistance in key pathogens, with warmer temperatures ...
  57. [57]
    [PDF] Biofilm Maturation and Resistance Quorum Sensing Connection
    Sep 9, 2025 · This chapter aims to address the issues of antibiotic resistance in biofilms by linking the processes of biofilm development and quorum sensing, ...
  58. [58]
    Ecological and evolutive implications of bacterial defences against ...
    Oct 31, 2011 · Bacterial communities are often heavily consumed by microfaunal predators, such as protozoa and nematodes. Predation is an important cause ...<|control11|><|separator|>
  59. [59]
    Capsular Polysaccharide Is Essential for the Virulence of the ...
    Clinical isolates of Enterobacter spp. display diverse susceptibility to human serum bactericidal activity. Little is known about the pathogenesis of ...
  60. [60]
    Enterobacter Bacteremia: An Analysis of 50 Episodes - JAMA Network
    We chose a random group of 50 cases for analysis. The disease was community acquired in 24% of the cases and nosocomially acquired in the remaining 76%.
  61. [61]
    The Impact of COVID-19 on the Epidemiology of Carbapenem ...
    Sep 11, 2025 · In Argentina, the RECAPT-AR study found a post-COVID rise in NDM (42%) and KPC (39.8%) among Enterobacterales, with frequent co-production of ...
  62. [62]
    Enterobacter species | Johns Hopkins ABX Guide
    Dec 11, 2024 · Gram-negative, aerobic, motile bacilli of the Enterobacteriaceae family that ferments lactose and forms mucoid colonies.
  63. [63]
    Urinary Tract Infection and Asymptomatic Bacteriuria in Older Adults
    Feb 7, 2018 · ASB is common in older adults; in one study of nursing home residents, 25–50% of subjects had bacteriuria at any given time [45]. After ...
  64. [64]
    Cellulitis - Dermatologic Disorders - Merck Manuals
    Symptoms and signs are pain, warmth, rapidly spreading erythema, and edema. Fever may occur, and regional lymph nodes may enlarge in more serious infections.
  65. [65]
    Neonatal Meningitis - StatPearls - NCBI Bookshelf - NIH
    For example, the most common signs in neonates weighing over 2500 grams include fever, irritability, seizures, and bulging fontanelle. In contrast, apnea, ...
  66. [66]
    Enterobacter Infections Workup: Laboratory Studies, Imaging ...
    Oct 3, 2024 · The most important test to document Enterobacter infections is culture. Direct Gram staining of the specimen also is very useful.
  67. [67]
    Clinical analysis of Enterobacter bacteremia in pediatric patients
    According to a large-scale survey conducted in the USA, Enterobacter cloacae accounted for 3.9% of all nosocomial bloodstream infections. ... At the same time, a ...
  68. [68]
    Parallel comparison of accuracy of API 20E, Vitek GNI, MicroScan ...
    Evaluation of a new commer- cial system for the identification of Enterobacteriaceae and non-fermentative bacteria. Eur. J. Clin. Microbiol. Infect. Dis. 11 ...
  69. [69]
    Design of genus-specific semi-nested primers for simple and ...
    Jul 28, 2025 · The genus Enterobacter was first proposed by E. Hormaeche and P. R. Edwards in 1960 based on biochemical characteristics [5]. With the ...<|separator|>
  70. [70]
    Comparing the Efficacy of MALDI-TOF MS and Sequencing-Based ...
    Jan 21, 2023 · MALDI-TOF MS generated 95.24% correct genus level identification of the cultivated 42 isolates which were higher than the results of 16S rRNA ...
  71. [71]
    Genetic Characterization of the O-Antigen and Development of a ...
    Apr 28, 2020 · Enterobacter cloacae is a well-characterized opportunistic pathogen that is closely associated with various nosocomial infections.
  72. [72]
    Rapid and accurate sepsis diagnostics via a novel probe-based ...
    Sep 30, 2025 · ... diagnostic tests (RDTs). However, syndromic panels and other multiplex PCR methods often fail to identify many pathogens and target ...
  73. [73]
    Clinical performance of a syndromic panel for direct identification of ...
    Sep 2, 2025 · The recovery of microbial pathogens from sterile body fluids in children poses challenges, including the low sensitivity of conventional ...
  74. [74]
    IDSA 2024 Guidance on the Treatment of Antimicrobial Resistant ...
    This guidance document provides recommendations to clinicians for treatment of infections caused by extended-spectrum β-lactamase producing Enterobacterales ...
  75. [75]
    Enterobacter Infections Treatment & Management
    Oct 3, 2024 · Enterobacter infections can include bacteremia, lower respiratory tract infections ... reduced to < 104 CFU/mL). Data showed about 98.4% of ...
  76. [76]
    Comparing the Outcomes of Adults With Enterobacteriaceae ... - NIH
    Oct 8, 2017 · The recommended duration of antibiotic treatment for Enterobacteriaceae bloodstream infections is 7–14 days. We compared the outcomes of ...Missing: rates | Show results with:rates
  77. [77]
    Carbapenem-resistant Enterobacterales (CRE) Infection Control
    Apr 12, 2024 · Enforce policies for core infection control practices like hand hygiene, personal protective equipment and environmental cleaning. Remind ...
  78. [78]
    The Potential of Probiotics to Eradicate Gut Carriage of Pathogenic ...
    Sep 8, 2021 · Probiotic supplements have been used to decrease the gut carriage of antimicrobial-resistant Enterobacterales through changes in the microbiota and metabolomes.
  79. [79]
    Effect of antimicrobial therapy on mortality in 377 episodes of ...
    Of 314 patients with monomicrobial Enterobacter bacteraemia, the overall 30 day mortality rate was 11.8% (37 of 314), and the infection-related mortality ...
  80. [80]
    Clinical characteristics and risk factors for attributable mortality in ...
    The overall mortality rate was 42.6%, and E. cloacae bacteremia-attributable mortality occurred in 22 patients (20.9%). Factors significantly correlated with ...
  81. [81]
    AmpC β-Lactamases - PMC - PubMed Central
    They are active on penicillins but even more active on cephalosporins and can hydrolyze cephamycins such as cefoxitin and cefotetan; oxyiminocephalosporins ...
  82. [82]
    Antibiotic Treatment of Infections Caused by AmpC-Producing ...
    Sep 21, 2024 · All AmpCs produced by Enterobacterales are able to hydrolyze penicillins, monobactams, and cephalosporins, including ceftaroline and ...
  83. [83]
    Extended-Spectrum-β-Lactamase, AmpC, and Carbapenemase Issues
    Apr 1, 2010 · AmpC β-lactamases preferentially hydrolyze narrow-, broad-, and expanded-spectrum cephalosporins and cephamycins and resist inhibition by ...
  84. [84]
    Review of AmpC Beta-Lactamases in the Enterobacterales ...
    May 15, 2021 · The AmpC beta-lactamase is an enzyme that is produced by Gram-negative bacteria and can hydrolyze a broad spectrum of beta-lactam antibiotics, ...
  85. [85]
    Efflux-Mediated Resistance to Fluoroquinolones in Gram-Negative ...
    This review focuses on efflux mechanisms of FQ resistance, their distribution and clinical significance in gram-negative pathogens.
  86. [86]
    Efflux-Mediated Resistance in Enterobacteriaceae - PubMed Central
    Aug 1, 2025 · Efflux is one of the key mechanisms used by Gram-negative bacteria to reduce internal antibiotic concentrations.
  87. [87]
    Plasmid-Mediated Spread of Carbapenem Resistance in ...
    Over 80% of 375 carbapenem-resistant determinants including KPC-, NDM-, VIM- and OXA-48-like ones detected in 520 Enterobacterales were plasmid-encoded, and ...
  88. [88]
    Multidrug-Resistant CTX-M-(15, 9, 2)- and KPC-2-Producing ...
    Genes coding for ESBLs (blaCTX−M, TEM, SHV) and carbapenemases (blaKPC, IMP, VIM, NDM, OXA−48) were also searched for using PCR and sequencing (Woodford et al., ...
  89. [89]
    A Review of Carbapenem Resistance in Enterobacterales and Its ...
    This review presents an overview of the factors that cause the emergence of AMR, particularly CRE, where they have been reported, and then, it outlines ...
  90. [90]
    Prevalence of Carbapenemase and Extended-Spectrum β ... - MDPI
    The carbapenem resistance rates in the current study ranged from 20–30% among Enterobacteriaceae, which is relatively lower than that reported in Sindh province ...
  91. [91]
    High Prevalence of Multidrug‐Resistant and Extended‐Spectrum β ...
    Apr 30, 2020 · Out of 440 isolates of Enterobacteriaceae, 42.1% were multidrug-resistant of which 34.3% and 8.95% were extensively drug-resistant and pan-drug ...2.3. Esbl Detection · 3. Results · 4. Discussion
  92. [92]
    National prevalence estimates for resistant Enterobacteriaceae and ...
    The estimated national proportion of resistant Enterobacteriaceae isolates in hospitalized patients was 12.6% for ESBL, 6.6% for MDR, and 1.2% for Carb-NS ...National Prevalence... · Proportion Of Resistant... · Resistance Rate Per 1000...<|control11|><|separator|>
  93. [93]
    High third-generation cephalosporin resistant Enterobacteriaceae ...
    Oct 20, 2016 · Late-onset infections are usually attributed to bacteria acquired from the infant's surroundings (hospitals or community), Klebsiella spp. and ...
  94. [94]
    Molecular Epidemiology of Third-Generation-Cephalosporin ...
    Consistent with global findings in Enterobacteriaceae, most (98.3%) isolates harbored at least one β-lactamase gene, with 144 (50%) harboring blaCTX-M-1 group, ...
  95. [95]
    Dissemination dynamics of colistin resistance genes mcr-9 ... - Nature
    Sep 25, 2025 · Here, we aim to elucidate the characteristics of mcr-9 and mcr-10 in a local population of Enterobacter species isolated from bloodstream ...Missing: emerging | Show results with:emerging
  96. [96]
    Prevalence of colistin-resistant Enterobacteriaceae isolated from ...
    Mar 29, 2025 · Subgroup analysis by country revealed significant variability in resistance rates, ranging from 0.5% in Djibouti to 50.95% in South Africa.
  97. [97]
    Colistin heteroresistance in Enterobacter due to base heterozygosity ...
    Sep 18, 2025 · Colistin resistance can be mediated by various mutations in the same strain after exposure to colistin, which provides the flexibility to ...
  98. [98]
    Biofilms as Promoters of Bacterial Antibiotic Resistance and Tolerance
    Not surprisingly, MDR clinical isolates of Enterobacteriaceae often exhibit loss of porin production [149,150]. Several genetic mechanisms reduce or prevent ...
  99. [99]
    Exploring molecular mechanisms of drug resistance in bacteria and ...
    Bacteria also adopt physical strategies like biofilm formation, which encases bacterial communities in protective matrices, making it difficult for antibiotics ...
  100. [100]
    An overview of the antimicrobial resistance mechanisms of bacteria
    Members of the Enterobacteriaceae are known to become resistant due to reducing the number of porins (and sometime stopping production entirely of certain ...
  101. [101]
    Class I integrons among multidrug resistant Enterobacter spp ... - NIH
    The study found 63.3% of Enterobacter isolates carried intI genes, and 93.3% showed multidrug resistance. Class I integrons were widespread and clinically ...
  102. [102]
    Genomic epidemiology and resistome dynamics of Enterobacter ...
    Jul 31, 2025 · Within this challenge, carbapenem-resistant Enterobacterales (CRE) pose a major threat, classified by WHO as critical Bacterial Priority ...
  103. [103]
    [PDF] Carbapenem-resistant Enterobacterales – third update - ECDC
    Feb 3, 2025 · Carbapenem resistance in Enterobacterales, such as Klebsiella pneumoniae and Escherichia coli, poses a significant threat to patients and ...Missing: syndromic sepsis
  104. [104]
    Multidrug-Resistant Enterobacter cloacae Complex Emerging as a ...
    By 2015, over 4% of ECC clinical isolates collected in the United States Veteran's Health Administration (VHA) nationwide were carbapenem non-susceptible, with ...Missing: percentage | Show results with:percentage
  105. [105]
    Impact of Antimicrobial Stewardship on Reducing ... - NIH
    Dec 4, 2023 · Its primary goals are to improve patient outcomes, reduce microbial resistance, and mitigate the spread of infections caused by multidrug- ...
  106. [106]
    Impact of antimicrobial stewardship on antibiogram, consumption ...
    Dec 7, 2022 · Antimicrobial stewardship programs are intended to improve patient outcomes, reduce side effects, bacterial resistance, and costs.<|control11|><|separator|>
  107. [107]
    Application of Antimicrobial Stewardship Interventions Improves ...
    Aug 11, 2025 · ASIs can reduce the time to appropriate antimicrobial therapy, shorten antibiotic therapy duration, and improve clinical outcomes in patients ...
  108. [108]
    The Effect of Enteric-Derived Lipopolysaccharides on Obesity - PMC
    Apr 13, 2024 · This review summarises the evidence for an interconnection between LPS, obesity, and gut flora, further expanding our understanding of LPS as a mediator of low ...
  109. [109]
    Roux-en-Y gastric bypass-induced bacterial perturbation contributes ...
    Jun 14, 2021 · Bariatric surgery exerts a profound effect on members of the gut microbiome altering the gut bacterial composition from Firmicutes and ...
  110. [110]
    The Gut Microbiome in Human Obesity: A Comprehensive Review
    Furthermore, the obese group exhibited an increased relative abundance of several bacterial taxa within the Enterobacteriaceae family, known for their endotoxic ...
  111. [111]
    Microbiome, Potential Therapeutic Agents: New Players of Obesity ...
    The gut microbiome significantly influences obesity ... Numerous studies have investigated the efficacy of FMT in treating obesity and metabolic syndrome.
  112. [112]
    Exploring the Gut Microbiota: Key Insights Into Its Role in Obesity ...
    Studies show that GM dysbiosis is linked to increased energy extraction, altered metabolic pathways, and inflammation, contributing to obesity, MS, and T2D. The ...
  113. [113]
    (PDF) Biodegradation of Crude Oil in Contaminated Water by Local ...
    Dec 18, 2018 · After 30 days of incubation, E. cloacae E1 degraded 70.00 ± 0.40% of the crude oil. GC-MS analysis revealed that E. cloacae E1 was able to ...
  114. [114]
    Isolation and Characterization of Oil-Degrading Enterobacter sp ...
    Apr 14, 2021 · The proposed mechanism for the degradation of crude oil by Enterobacter cloacae subsp. may be cell uptake, which is comprised of two parts.
  115. [115]
    Chromium(VI) bioreduction and removal by Enterobacter sp. SL ...
    A technology utilizes bacteria Enterobacter sp. SL grown in an anaerobic reactor with waste molasses as carbon source to bio-reduce hexavalent chromium ...
  116. [116]
    Cr(VI) reduction by Enterobacter sp. DU17 isolated from the tannery ...
    Newly isolate Enterobacter sp. DU17 reduced Cr(VI) extracellularly. · Complete reduction of 100 mg L−1 Cr(VI) noticed within 16 h in presence of glucose.
  117. [117]
    Harnessing bacterial consortia for effective bioremediation: targeted ...
    Jun 4, 2025 · Enterobacter kobei FACU6 has also demonstrated remarkable bioremediation potential, efficiently removing lead (83.4%, 571.9 mg/g) with a maximum ...
  118. [118]
    Fipronil Degradation in Soil by Enterobacter chengduensis Strain G2.8
    Enterobacter chengduensis was able to biodegrade fipronil (96%) and its metabolites fipronil-sulfone (92%) and fipronil-sulfide (79%) in 14 days.
  119. [119]
    [PDF] Enterobacter cloacae PNE2 As Promising Plant Growth Promoting ...
    The isolate Enterobacter cloacae PNE2 has multiple growth-promoting activities like N2 fixation, phosphate, solubilization, potassium solubilization, ...
  120. [120]
    Improvement of plant growth and seed yield in Jatropha curcas by a ...
    Oct 1, 2013 · Our results showed that Enterobacter sp. R4-368 significantly promoted growth and seed yield of J. curcas. The application of the strains is ...
  121. [121]
    Enterobacter cloacae Rs-2 inoculum replaces fertiliser application ...
    Rs-2 inoculum can replace 50% of fertilizer, increase soil nutrient content, and increase beneficial bacteria while reducing pathogenic fungi.
  122. [122]
    Enterobacter sp. DBA51 produces ACC deaminase and promotes ...
    Enterobacter sp. strain DBA51 presented several plant growth-promoting traits (ACC-Deaminase, IAA production, phosphate solubilization).
  123. [123]
    Bioethanol production by Enterobacter hormaechei through carbon ...
    Sep 8, 2022 · E. hormaechei RF2 is high ethanol tolerant and genetically stable bioethanol producer that can be exploited for pilot-scale production to meet the rising ...
  124. [124]
    Production of 2,3-butanediol by newly isolated Enterobacter cloacae
    The major product of fermentation by the bacterium was meso-2,3-butanediol (2,3-BD). In a typical fermentation, a BD yield of 0.4 g/g arabinose was obtained.
  125. [125]
    Production and physicochemical properties of thermostable, crude ...
    Aug 6, 2025 · Mutagenesis of Enterobacter cloacae IP8 for enhanced cellulase production was carried out using ultraviolet (UV) irradiation and ethyl ...
  126. [126]
    Quorum Sensing in Gram-Negative Bacteria: Small-Molecule ...
    Numerous species of bacteria employ a mechanism of intercellular communication known as quorum sensing. This signaling process allows the cells comprising a ...<|separator|>
  127. [127]
    Commensal Enterobacteriaceae Protect against Salmonella ...
    Jan 9, 2019 · These results suggest that commensal Enterobacteriaceae contribute to colonization resistance by competing with S. Enteritidis for oxygen, a resource critical ...
  128. [128]
    [PDF] Heterotrophic denitrification by Enterobacter hormaechei collected ...
    Therefore, it could be suggested that, of the two tested carbon sources, sodium-succinate is more appropriate to be used for the treatment of wastewater ...
  129. [129]
    US20240026113A1 - Plastic-degrading solution - Google Patents
    The plastic-degrading solution can include bacteria suitably selected from among Flavobacterium, Enterobacter asburiae, Ideonella sakaiensis, Thermobifida fusca ...
  130. [130]
    Enhancement of low-density polyethylene biodegradation through ...
    Jul 2, 2025 · Bioaugmentation of Enterobacter cloacae AKS7 causes an enhanced degradation of low-density polyethylene (LDPE) in soil: a promising approach ...
  131. [131]
    Genomic and biotechnological potential of a novel oil-degrading ...
    As Enterobacter kobei DH7 has demonstrated significant oil degradation potential, it is one of the good candidates for application in the bioremediation of oil ...