Enterobacter infection, treatment

Skin and skin-structure infections caused by E. coli, Klebsiella sp., Serratia sp., Acinetobacter sp., Enterobacter sp., P. aeruginosa indole-positive Proteus sp., P. mirabilis, Bacteroides sp., including B. fragilis, anaerobic cocci, enterococci Bone and joint infections caused by P. aeruginosa, enterococci, Bacteroides sp., and anaerobic cocci Gonococcal infections, treatment of uncomplicated gonococcal urethritis... 

The sulfonamides are often used to control urinary tract infections caused by certain bacteria such as Escherichia coli, Staphylococcus aureus, and Klebsiella-Enterobacter. Mafenide (Sulfamylon) and silver sulfadiazine (Silvadene) are topical sulfonamides used in the treatment of second- and third-degree bums. Additional uses of the sulfonamides are given in the Summary Drug Table The Sulfonamides. 

Urinary tract infections Nalidixic acid is indicated for the treatment of urinary tract infections (UTIs) caused by susceptible gram-negative microorganisms, including the majority of Escherichia coli, Enterobacter species, Klebsiella species, and Proteus species. Perform disc susceptibility testing with the 30 meg disc prior to administration of the drug and during treatment if clinical response warrants. 

Urinary tract infections (UTIs) For the treatment of UTIs when caused by susceptible strains of Escherichia coli, enterococci, Staphylococcus aureus, and certain susceptible strains of Klebsiella and Enterobacter species. 

May be effective in the treatment of acute urinary tract infections caused by susceptible strains of gram-positive and gram-negative bacteria, especially Enterobacter sp. and Escherichia coii. It usually is less effective than other antimicrobial agents in the treatment of urinary tract infections caused by bacteria other than mycobacteria. Consider using only when the more conventional therapy has failed and when the organism has demonstrated sensitivity. 

Local treatment of skin and soft tissue infections with antibiotic-containing ointments or solutions should not be used because it leads to allergic reactions and rapid development of bacterial resistance. In settings where MRSA or resistant Enterobacte-riaceae (like ESBL s gram negative bacteria with extended spectrum beta lactames) or Pseudomonas spp. occur, the empiric use of vancomycin and a carbapenem can be necessary. The risk of transmission of these organisms should be minimalised by hygienic and isolation measures. 

Within the last few years, some new sulfa drugs have been introduced, including tnmethoprim-sulfamethoxazole. This drug has broadened the scope in treatment of urinary tract infections derived from species in addition to E. coli, namely, Klebsiella, Enterobacter, and Porteus species. This drug also is used for the treatment of acute otitis media in children, particularly those instances where strains uf H. influenzae and streptococcus pneumoniae may be suspected. The drug is also used to treat systemic infections that may arise from chloramphenicol- and ampicillin-rcsistant Salmonella as well as infections attributed to Pneumocystis carinii. 

Kanamycin can be used for short-term treatment of severe infections caused by susceptible strains (for example Escherichia coli, Proteus species, Enterobacter aerogenes, Klebsiella pneumoniae, Serratia marcescens, and Mima-Elerellea) that are resistant to other less ototoxic aminoglycosides. It is not indicated for long-term therapy, for example in tuberculosis. 

Parodi S, Lechner A, Osih R, et al. Nosocomial enterobacter meningitis Risk factors, management, and treatment outcomes. Clin Infect Dis 2003 37 159-166. 

Carbenicillin is indicated in the treatment of acute and chronic infections of the upper and lower urinary tract and in asymptomatic bacteriuria due to susceptible strains of Escherichia coli, Proteus mirabilis, Morganella morganii, Providencia rettgeri, P. vulgaris, Pseudomonas, Entero-bacter, and enterococci. It is also indicated in the treatment of prostatitis due to susceptible strains of E. coli, enterococcus (S. faecalis), P. mirabilis, and Enterobacter species. 

Imipenem-cilastatin is effective for a wide variety of infections, including urinary tract and lower respiratory infections intra-abdominal and gynecological infections and skin, soft tissue, bone, and joint infections. The drug combination appears to be especially useful for the treatment of infections caused by cephalosporin-resistant nosocomial bacteria, such as Citrobacter freundii and Enterobacter spp. It would be prudent to use imipenem for empirical treatment of serious infections in hospitalized patients who have recently received other P-lactam antibiotics because of the increased risk of infection with cephalosporin- and/or penicillin-resistant bacteria. Imipenem should not be used as monotherapy for infections owing to P. aeruginosa because of the risk of resistance developing during therapy. 

Ticarcillin, extended-spectrum penicillin, alpha-carbox-ypenicillin, is indicated for the treatment of bacterial septicemia, skin and soft-tissue infections, acute and chronic respiratory tract infections caused by susceptible strains of Pseudomonas aeruginosa, Proteus species (both indole-positive and indole-negative), and Escherichia coli and for genitourinary tract infections (complicated and uncomplicated) due to susceptible strains of P. aeruginosa, Proteus species (both indole-positive and indole-negative), E. coli, Enterobacter, and Streptococcus faecalis (enterococcus). 

The fourth-generation cephalosporins are indicated for the empirical treatment of nosocomial infections where antibiotic resistance owing to extended-spectrum /J-lactamases or chromosomaUy induced /1-lactamases is anticipated. For example, cefepime is superior to ceftazidime and piperacillin for nosocomial isolates of Enterobacter, Citrobacter, and Serratia spp. 

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