Dietrich L#, Fuest L# and Vögelin E*
Department of Hand and Peripheral Nerve Surgery, University Hospital Bern, Switzerland
#These authors contributed equally to this work
Introduction: Posttraumatic monomicrobial infections with Enterobacter cloacae (EC) is rare. Serious complications and subsequent interventions raised the attention to examine such cases in more detail. This is a retrospective analysis of complications, treatment strategy and outcomes of post-traumatic EC monomicrobial infections. Methods: Patients with EC monomicrobial infections treated from 2008–2017 were considered. Nature of trauma, location, injured structures, time from trauma to surgery, pathogens, number of surgical treatments, antimicrobial therapy, complications, and outcome were assessed. Results: From 2008-2017, 6 patients with EC monomicrobial infection were identified. They were all male; the median age was 38 years. Two severe cases were initially treated surgically at the day of trauma, 4 milder cases were initially treated conservatively and surgery delayed by at least 1 day. None of the patient had initially positive bacterial swabs but routinely given general antibiotic therapy with amoxicillin/clavulanic acid until EC was confirmed after 3 to 120 days (average 30 days). Infection was successfully controlled with one intervention in 4 cases, 2 interventions in 1 case and 3 interventions in 1 case. Four patients developed complications. Following availability of microbiological tissue samples the antibiotic of choice was tailor made and patients treated with the correct antibiotic cefepime or ciprofloxacin for a median time of 30 days. Conclusion: Posttraumatic EC monomicrobial infections were rare but may lead to complications with the need of interventions and a loss of hand function. Initial tissue samples of infected tissue extremely important in order to treat the correct contaminant. Early surgical intervention is paramount.
Dietrich L, Fuest L, Vögelin E. Monomicrobial Enterobacter cloacae Infections in Extensive Hand Injuries - A Case Series. Clin Surg. 2022; 7: 3465..