Maximilian Mauritz (Datteln / DE), Benedikt Claus (Datteln / DE), Johannes Forster (Würzburg / DE), Markus Petzold (Dresden / DE), Sophie Schneitler (Homburg / DE), Alexander Halfmann (Homburg / DE), Susanne Hauswaldt (Lübeck / DE), Dennis Nurjadi (Lübeck / DE), Nicole Toepfner (Dresden / DE)
Introduction: Enterobacter cloacae complex (ECCO) comprises closely related Enterobacteriaceae, causing various infections ranging from mild urinary tract infections to severe bloodstream infections [1]. In particular, ECCO has emerged as a significant cause of healthcare-associated infections, particularly in neonatal and adult intensive care [2]. Increasing broad-spectrum antibiotic resistance in ECCO has become an important public health concern [3].
Goals: The aim of this "Enterobacter Cloacae COMplex PASsive Surveillance" (EC-COMPASS) is to provide a detailed overview of the epidemiology and resistance patterns of ECCO isolates detected in routine microbiological diagnostics in four German tertiary care hospitals.
Materials & Methods: Routine microbiological diagnostic data was extracted from the laboratory information systems via Hybase® software of four German tertiary care hospitals.
Results: Analysis of datasets from 14,311 patients revealed a higher incidence in male patients. Sources of ECCO were swabs, urine, respiratory secretions, blood cultures, and tissue samples. The highest proportion of invasive ECCO isolates relative to the number of total detections was seen in the oncology, medical ICU, and surgical ICU departments (Figure 1). Carbapenem resistance was 0.6%, with no major temporal variation between the hospitals.
Summary: The EC-COMPASS provides a comprehensive overview of ECCO infections and colonization in tertiary medical care patients. Clinical specimens most likely came from the Internal Medicine, General Surgery, and Neonatology departments. Detection in urine samples and respiratory specimens was most frequent. Bloodstream infections primarily affect older men treated in the oncology or ICU.
[1] Mezzatesta ML et al. Enterobacter cloacae complex: clinical impact and emerging antibiotic resistance. Future Microbiol 2012;7:887–902.
[2] Dalben M et al. Investigation of an outbreak of Enterobacter cloacae in a neonatal unit and review of the literature. J Hosp Infect 2008;70:7–14.
[3] Annavajhala MK et al. Multidrug-Resistant Enterobacter cloacae Complex Emerging as a Global, Diversifying Threat. Front Microbiol 2019;10:44.