Clinical Epidemiology of Enterobacter Cloacae Complex
Summary
The Enterobacter cloacae complex comprises a group of closely related Gram-negative bacteria that have emerged as significant opportunistic pathogens within healthcare settings worldwide. These organisms are frequently implicated in bloodstream, urinary tract and respiratory infections, particularly among immunocompromised or critically ill patients. Epidemiological surveillance has revealed a broad distribution of sequence types and phylogenetic clades, underpinned by a capacity to acquire and disseminate plasmid-borne resistance determinants. Of particular concern is the rising prevalence of strains resistant to carbapenems and polymyxins, which undermines last-resort therapies and elevates morbidity and mortality. Whole-genome sequencing has been instrumental in delineating clonal expansions and inter-hospital transmission, while population genomics studies continue to unravel the diversity of mobile genetic elements, integrons and two-component regulatory systems that drive both antimicrobial resistance and virulence. Moreover, heteroresistance to colistin, mediated by lipid A modifications, and the role of capsular polysaccharide in immune evasion further complicate therapeutic strategies, while ongoing taxonomic refinements improve species identification. Global reports highlight regional variation in predominant lineages and resistance mechanisms, emphasising the need for coordinated surveillance, rigorous infection control practices and tailored antibiotic stewardship. Laboratory advances in diagnostic assays, including those for detecting colistin resistance, promise to enhance clinical management and curb the spread of multidrug-resistant clones.
Research from Nature Portfolio
Recent studies have characterised the genetic basis of colistin resistance and heteroresistance within the complex, demonstrating that variation in lipid A modification pathways dictates susceptibility to this last-line antibiotic. Comparative genomic and mutational analyses have revealed that allelic differences in two-component systems and regulatory peptides modulate expression of the arnBCADTEF gene cassette, which in turn governs L-Ara4N addition to lipid A. These insights have underpinned the development of a standardised assay capable of accurately detecting colistin resistance levels across diverse Enterobacter cloacae complex isolates, offering a crucial tool to guide therapy and mitigate treatment failures.
Clinical Epidemiology of Enterobacter Cloacae Complex publication trend
The graph below shows the total number of articles in clinical epidemiology of enterobacter cloacae complex across all publications each year (not limited to Nature Index journals).
Technical terms
Nosocomial pathogen: A microorganism that causes infection in hospitalised patients.
Heteroresistance: The presence of subpopulations within a bacterial isolate that exhibit different susceptibilities to an antibiotic.
Integron: A genetic element that captures and expresses gene cassettes, often encoding antibiotic resistance.
Sequence type (ST): A classification based on allelic profiles of housekeeping genes used in multilocus sequence typing.
Lipid A: A component of the lipopolysaccharide anchor in Gram-negative bacteria and a target of polymyxin antibiotics.
Plasmid: A self-replicating DNA molecule that often carries antibiotic resistance genes and facilitates horizontal gene transfer.
References
- Resolving colistin resistance and heteroresistance in Enterobacter species. Nature Communications (2023).
- Emergence and transmission of the high-risk ST78 clone of OXA-48-producing Enterobacter hormaechei in a single hospital in Taiwan. Emerging Microbes & Infections (2024).
- Distribution characteristics of integrons and correlation analysis of antibiotic resistance in urine isolated Enterobacter cloacae. Frontiers in Cellular and Infection Microbiology (2024).
- Antimicrobial Resistance Patterns of Enterobacter cloacae and Klebsiella aerogenes Strains Isolated from Clinical Specimens: A Twenty-Year Surveillance Study. Antibiotics (2023).
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