E. Cloacae is a bacterium from the genus Enterobacter and is a natural component of the human digestive system. It is also rod-shaped, gram-negative and belongs to the Enterobacteriaceae family (Davin-Regli & Pagès, 2015). Its size ranges from approximately 0.3-0.6 by 0.8-2.0 micrometers. Nevertheless, this bacterium can also be found in more habitats such as in water, plants, insects, food, fecal materials, and even soil. The bacterium lives in a mesophilic environment, with its most ideal temperatures being about 37 degrees centigrade. Additionally, it has flagella for movement, which means it is motile. The bacterium can also survive in environments with or without oxygen, that is, this group of bacteria can make ATP by aerobic respiration when an adequate supply of oxygen is present but can also turn to fermentation when oxygen is absent.
Cell Structure and Metabolism
E. Cloacae are gram-negative and that means that their cell structure comprises two cell membranes. The outer membrane contains Lipid-A which is responsible for sepsis. Lipid-A triggers the release of cytokines that could lead toxins to be transmitted through the tissues as well as the bloodstream. Secondly, the bacteria have beta-lactamase, an enzyme that is linked to antibiotic resistance during the treatment process and that is also difficult to detect in vitro (Davin-Regli & Pagès, 2015). This group of bacteria is also glucose fermenters, and can consequently survive in both anaerobic and aerobic environments.
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It is also noted that Enterobacter cloacae under anaerobic conditions can break down selenite to selenium to maintain its cells. For this process to occur, a chemical known as menaquinone is required that functions as an electron carrier. When selenite is reduced using menaquinone, a proton motive force is produced, which allows the cell to grow gradually in anaerobic environments, and consequently, maintain the cells. Selenite is commonly discharged in water especially from industrial activities and is soluble as well as toxic. It has always been linked to the death of many aquatic animals. However, Enterobacter cloacae can break it into Selenium which is insoluble and non-toxic. Perhaps this could be one of the benefits of the bacteria in the digestive system.
Occurrence
The bacteria can be found in many environments especially because of their ubiquitous nature. For instance, they can be found on human skin and tissues, vegetables, fruits, and equipment such as hot water treatment tanks. The bacteria are also likely to be found in sewage systems, and generally, environments with poor hygiene standards. Although the bacteria are mainly pathogens for humans and cause illnesses, they have also been used immensely as biological control agents for plant diseases as well as to control insect pests, a prominent example being in mulberry leaves.
Pathology
The bacteria are nosocomial pathogens and can be transmitted through the skin, urinary tract, gastrointestinal tract or even acquired externally because of their ubiquitous nature. They are also opportunistic pathogens, meaning that individuals with weakened immune systems are likely to get infected. For instance, children and elderly individuals conventionally have weaker immune systems and could therefore easily get infected. Additionally, patients suffering from severe diseases like human immunodeficiency virus or other chronic illnesses are at risk. Nosocomial infections are most common from these bacteria. It means people mostly contract diseases caused by the bacteria as a consequence of being hospitalized. For example, in 2010, there was a lot of concern in Germany after three babies died in one weekend after being infected by Enterobacter cloacae while at Mainz University Hospital (DW, 2010). The three babies were part of a group of about eleven infants prematurely born and were receiving nutrition intravenously because they were still too weak or ill to be breast-fed normally. It was widely believed that the tubes the babies used were contaminated and had not been cleaned properly, therefore, promoting an ideal environment for the Enterobacter cloacae to reproduce and survive.
Enterobacter cloacae bacteria cause several diseases or infections. Some of the most prominent ones include bacteremia, septic arthritis, endocarditis, osteomyelitis, lower respiratory tract-urinary tract, and intra-abdominal infections, as well as skin or soft tissue infections. In line with the German example, Enterobacter cloacae are mainly known to contaminate hospital medical and intravenous devices. That means hospital surgical equipment and feeding or breathing pipes or tubes could be contaminated if the hospital staff is negligent and does not practice adequate hygiene standards. It is also important to note that Enterobacter cloacae bacteria only cause infections when they enter the bloodstream. Normally, the bacteria can be found within the digestive system and exists in a symbiotic relationship. As noted earlier, although researchers cannot pinpoint the specific benefits of these bacteria, they could be helpful in breaking down some toxic elements into harmless forms. For instance, they can break down selenite into selenium, reducing the fatal effects of the former.
Prevention
Even before dealing with intervention efforts in healthcare settings, prevention strategies need to start from the household level. Many households currently have sewage systems, especially septic tanks. These systems need to be covered properly and treated from time to time. Water pipes, especially in kitchens and bathrooms, should also be treated to avoid contamination. Another important thing is the proper cleanliness of toilets because it is noted that places with fecal material could offer an ideal breeding ground for the bacteria. Therefore, toilets need to be flushed each time they are used, in addition to cleaning them using recommended disinfectants. Individuals should also use sterilized equipment to prevent contamination.
The hospital environment is said to contribute greatly towards the transmission of infections caused by Enterobacter cloacae. This comes in the wake of initiatives and interventions to prevent hospital-acquired infections. Just like in households, healthcare environments also need to practice adequate hygiene and cleanliness standards. Prenatal facilities especially need to be cleaned using proper disinfectants and equipment used also needs to be sterilized (Davin-Regli & Pagès, 2015). Secondly, there should be proper disposal of used devices such as syringes and surgical tools. Such equipment should be disposed of immediately once they are used. Thirdly, the healthcare environment needs to be devoid of clumsiness, that is, it should not be stuffy because it could hamper proper hygiene efforts.
Treatment
Enterobacter cloacae are difficult to mitigate in practice. The reason is that they could easily become resistant even to novel treatment strategies. For instance, currently, the bacteria are resistant to most antibiotics, a factor that is prompting researchers to develop new treatment methods. However, the most effective agent against these bacteria is aminoglycosides (Davin-Regli & Pagès, 2015). Additionally, antibiotics such as cefoperazone and cefotaxime are in use presently and can be used as the basic drugs in the fight of infections caused by these bacteria.
In conclusion, Enterobacter cloacae bacteria’s ubiquitous nature makes it difficult to prevent and treat. Additionally, this difficulty is also reinforced by bacteria’s resistance nature to most of the antibiotics used. Even the new antibiotics currently used may be obsolete with time; hence researchers may be compelled to develop newer treatments in the future. The hospital environment is noted to contribute greatly towards the acquisition of infections resulting from Enterobacter cloacae, and consequently, it is best to prevent the infections than to treat them because once acquired, they could cause rapid death especially in patients with weak immune systems. Therefore, it is important to maintain proper cleanliness and hygiene standards both at home and within the healthcare settings.
References
Davin-Regli, A., & Pagès, J.-M. (2015). Enterobacter aerogenes and Enterobacter cloacae; versatile bacterial pathogens confronting antibiotic treatment. Frontiers in Microbiology , 6 , 392. doi: 10.3389/fmicb.2015.00392
DW. (2010). “ Enterobacter cloacae bacteria can cause death rapidly if not treated quickly”. https://www.dw.com/en/enterobacter-cloacae-bacteria-can-cause-death-rapidly-if-not-treated-quickly/a-5938943
