Microbiology
gram-negative rods, includes E. aerogenes, E. agglomerans, E. cloacae, E. gergoviae, E. sakazakii (now Cronobacter sakazakii).
Epidemiologic Risks
Hospitalization. Widespread in the environment.
Syndromes
Nosocomial infections of all kinds.
Obesity on germ-free mice (PubMed). Dcon is still a more reliable way to rid the house of mice.
Treatment
Ceftazidime, cefepime (PubMed), carbapenems (best), aminoglycosides, quinolone (best).
Ceftazidime-avibactam has a high failure rate with CRE with resistance common, although it may be better than the options (PubMed) and is useful for the KPC beta-lactamases, although resistance can occur on therapy.
Ceftazidime-avibactam and aztreonam (PubMed)(PubMed) for CRE
There is also meropenem/vaborbactam for some CRE strains, depending on the beta-lactamase.
Notes
It can have an inducible beta-lactamase that confers resistance to 2nd and third-generation cephalosporins as well piperacillin. This resistance can takes days to show up, while the rapid susceptibility testing can be done in hours. The bottom line is that it can look sensitive to cefotaxime or piperacillin and not be.
Last update: 12/22/18