Intensive care unit-acquired complicated necrotizing pneumonia caused by Enterobacter cloacae: A case report

Area of Science:

• Infectious Diseases
• Critical Care Medicine
• Microbiology

Background:

• Intensive care unit (ICU)-acquired pneumonia presents a significant challenge in patient management.
• Complicated pneumonia can rapidly progress to life-threatening conditions.

Observation:

• A patient with diabetes and end-stage renal disease developed severe pneumonia in the ICU.
• Despite initial broad-spectrum antibiotics, the patient's condition worsened, progressing to necrotizing pneumonia with abscess, empyema, and pneumothorax.
• Post-mortem cultures identified Enterobacter cloacae as the causative agent, resistant to ceftazidime but susceptible to imipenem.

Findings:

• Enterobacter cloacae was identified as the sole pathogen responsible for the fatal necrotizing pneumonia.
• The bacterium exhibited resistance to ceftazidime, an initial empirical treatment, highlighting the importance of pathogen-specific susceptibility.
• Rapid progression to severe complications including lung abscess, empyema, pyopneumothorax, and tension pneumothorax occurred.

Implications:

• Enterobacter cloacae should be considered in the differential diagnosis of rapidly progressive, complicated ICU-acquired pneumonia.
• Prompt initiation of carbapenem therapy is recommended for suspected cases until definitive pathogen identification and susceptibility are known.
• Increased physician awareness of E. cloacae-induced pneumonia is vital for timely diagnosis and effective treatment, potentially improving outcomes in critical care settings.