Case Report of Enterobacter cloacae Producing IMP-8 Carbapenemase Isolated from Secretions of Burn Patients and Diabetes Patients with Diabetic Foot

Introduction: With the widespread use of cephalosporins, Enterobacter cloacae has become an increasingly important pathogen of nosocomial infections, which causes bacterial infectious diseases involving multiple organ systems. The presence of carbapenem-resistant strains has resulted in problems in the current clinical anti-infective treatment. The current study reports on four cases of carbapenem-resistant E. cloacae secretion infection in order to provide suggestions for the detection and treatment of these pathogen infections. Case Presentation: Investigation of 4 cases was conducted at tertiary care hospitals, and baseline data, treatment and outcomes were collected for patients with carbapenem-resistant E. cloacae infection. The strains of burn injury and diabetic foot infection were retrieved from specimens by culture-based methods, and antibiotic sensitivity test was conducted on Vitek 2. All strains showed minimum inhibitory concentration (MIC) values for ertapenem, imipenem, and meropenem of less than 4 mu g/mL. The four strains of E. cloacae produced IMP-8 type carbapenemase confirmed by PCR and sequence analysis. After the selection of reasonable antibiotic treatment, the patient's condition had improved and they were discharged from the hospital. Conclusions: Low MIC value makes it difficult to detect IMP-8-harboring strains by traditional susceptibility test; molecular biology techniques may be mandatory for detection of carbapenem resistant isolates. It is very important to treat patients with reasonable antimicrobial based on susceptibility results.