Enterobacter cloacae

Question

Hello,

I have a 19-month-old daughter with CF. Last week we noticed an infection with her, and a throat swab that was subsequently done at the CF clinic showed that she had enterobacter cloacae.

The doctor at the clinic does not want to treat this germ any further. He says it has not been proven that this germ will cause any problems in CF patients, but one should keep in mind in later antibiotics therapies that she has (or had) this germ.

Is it really true that one should not do anything against this germ? Will it not spread if it is not treated?

Many thanks.
Anna

Answer

Dear Anna,

From my point of view, there are no objections to the treating doctor’s observant approach.

Enterobacter cloacae is a germ that belongs to the group of enterobacteriaceae. E. cloacae are widespread and occur especially in the intestines of humans and animals. Since it is also a water germ, it is routinely also to be found in water or humid areas. Proof of e. cloacae in material from the upper respiratory tract is rather unusual in adults, but is not of primary pathological significance, either. This is no different in toddlers. Different enterobacteriaceae are found much more frequently in children due to their tendency to stick certain objects and their hands into their mouths while at the same time not doing consistent hand hygiene. In addition, enterobacteriaceae can usually only be proven for a short time in children. A one-time proof of e. cloacae from a throat swab would therefore rather primarily point to a momentary colonization (chance finding).

In individual cases, one could try to get to the bottom of a proof of these bacteria from respiratory material, of course. In the case you are describing, proof was gained during clarification of an infection with CF. E. cloacae is not among the recognized CF germs, i.e. those germs that have been proven or are very likely to contribute to the progression of the disease in the lungs. Additionally, the infection is most likely to have another cause (e.g. caused by a virus). Therefore, and also given what I said above, there is no indication for therapy of enterobacter. However, it cannot be ruled out completely that the simultaneous presence of e. cloacae may also influence the infection negatively. If at all, an antibiotics therapy targeted against enterobacter should only be discussed in case of long-term symptoms and persistency of e. cloacae without proof of any other germs.

In addition, the observant approach does not constitute any type of failure. Particularly at the age of your child, there is no danger of permanent damage or chronification.

In case of an antibiotics therapy, potential desirable results should always be measured against potential undesired ones. In my opinion, in the case you are describing, the potential disadvantages of an antibiotics therapy outweigh the questionable benefits (relevance of e. cloacae).

Kind regards
Michael Hogardt

14.09.2010