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a Gram-negative, nonspore-forming, enteric bacilli

part of the Enterobacteriaceae family

Enterobacter cloacae complex is part of the Enterobacteriaceae family. E cloacae complex is a group of six closely related species with similar resistance patterns: E. cloacae, E. asburiae, E. hormaechei, E. kobei, E. ludwigii, and E. nimipressuralis. This gram-negative bacterium is considered dysbiotic at levels of 3+ or greater. E. cloacae complex is considered an opportunistic pathogen associated with diarrhea in children. A Shiga-like toxin-producing E. cloacae was isolated from the feces of an infant with hemolytic-uremic syndrome. However, E. cloacae complex is most often involved in extraintestinal infections including the urinary tract, respiratory tract, and cutaneous wounds. Widely distributed in the environment, Enterobacter spp. is commonly isolated from both human and animal feces. Environmental strains of Enterobacter spp. are capable of growth in foods at refrigeration temperature. E. cloacae complex is known to possess inducible ß-lactamases. Isolates may become resistant to all cephalosporins after initiation of therapy. Avoid ß-lactam-inhibitor drugs such as amoxicillin/ clavulanate, ampicillin/sulbactam, and piperacillin/tazobactam. Antibiotics may be indicated in systemic infections if symptoms are prolonged.

Opportunistic Bacteriology

Enterobacter are gram-negative bacteria that are classified as facultative anaerobes, which means that they are able to thrive in both aerobic and anaerobic environments. Enterobacter in the human microbiota is a pathogenic (=disease-causing) organism or is capable of becoming pathogenic. Studies have found specific bacteria such as Enterobacter aerogenes are sensitive to melatonin rhythms. As melatonin is secreted from the gut lining, it can cause an increase in Enterobacter aerogenes. This suggests our circadian rhythms may be regulated more closely alongside specific bacterial clocks than we previously realized. [L] References: – https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0146643 – https://www.ncbi.nlm.nih.gov/pubmed/26751389 – https://www.sciencedirect.com/topics/medicine-and-dentistry/enterobacteriaceae – https://www.sciencedaily.com/releases/2018/05/180531102753.htm – https://www.nature.com/articles/ismej2012153

gut dysbiosis

a large family of bacteria within the Proteobacteria phyla

This nematode inhabits the large intestine and migrates to the anus at night, where it deposits eggs on the perianal surface. Pinworm is the most common worm infection in the United States. School-age children, followed by preschoolers, have the highest rates of infection. Perianal pruritus, especially at night, is a characteristic symptom. Disturbed sleep, loss of appetite, restlessness and irritability may be experienced with heavy infection. Very rarely, E. vermicularis will migrate to the urinary bladder, vagina, or peritoneal cavity. All infected individuals in a communal group should be treated simultaneously. Eggs can survive up to 2 weeks on clothing or bedding, so laundering these items is imperative during treatment. Mebendazole (100 mg x 1 dose, repeat in 2 weeks) or pyrantel pamoate (11 mg/kg <1.0 gm qd x 1 dose, repeat in 2 weeks, adult dose) are effective drug treatments. Natural agents include quassia, black walnut, and garlic.

Gram-positive species in the Firmicutes phylum.

Indicator of gut health, balance, and potential dysbiosis in GI tests.

Enterococcus faecalis, a notable marker in urinary tract infection (UTI) panels, such as those offered by RealTime Laboratories, is a significant bacterium due to its role in various infections. As a gram-positive, facultative anaerobic organism, E. faecalis is commonly found as part of the normal intestinal flora but can cause a variety of infections including urinary tract infections, endocarditis, and bacteremia. Urinary tract infections caused by E. faecalis are particularly noteworthy. These infections often occur in chronically ill patients, especially in nosocomial settings, and can be associated with factors like urinary catheterization or obstruction. E. faecalis is capable of causing complicated UTIs, such as pyelonephritis, perinephric abscesses, and chronic prostatitis, which can also lead to bacteremia. The treatment of E. faecalis infections varies based on the site of infection and susceptibility testing. In the context of urinary tract infections, if the causative organism is sensitive, treatment usually involves a single antibiotic such as ampicillin or amoxicillin. However, E. faecalis has shown intrinsic resistance to several antibiotics, including cephalosporins, clindamycin, aminoglycosides, and trimethoprim-sulfamethoxazole. Additionally, it has gained antibiotic resistance through the acquisition and transfer of resistance-related mobile genetic elements, making the treatment of infections it causes more challenging. Over the past decades, resistance to multiple antimicrobials, especially among E. faecium, a close relative of E. faecalis, has increased rapidly. This resistance includes aminoglycosides, such as gentamicin and streptomycin, and vancomycin-resistant enterococci (VRE) strains that may also be resistant to other glycopeptides and beta-lactams. For more detailed information on Enterococcus faecalis and its implications in urinary tract infections, you can refer to resources provided by the Merck Manuals Professional Edition and StatPearls on NCBI Bookshelf.