scholarly journals Enterobacter aerogenes and Enterobacter cloacae; versatile bacterial pathogens confronting antibiotic treatment

2015 ◽  
Vol 6 ◽  
Author(s):  
Anne Davin-Regli ◽  
Jean-Marie Pagès
Keyword(s):  
Antibiotic Treatment ◽  
Bacterial Pathogens ◽  
Enterobacter Aerogenes ◽  
Enterobacter Cloacae

Антимікробна резистентність провідних збудників інфекцій сечових шляхів у Києві (Україна)

2017 ◽  
Vol 1 (2) ◽  
pp. 48-60
Author(s):  
A.G. Salmanov ◽  
A.V. Rudenko
Keyword(s):  
Escherichia Coli ◽  
Pseudomonas Aeruginosa ◽  
Klebsiella Pneumoniae ◽  
Staphylococcus Epidermidis ◽  
Klebsiella Oxytoca ◽  
Enterobacter Aerogenes ◽  
Enterobacter Cloacae ◽  
Proteus Vulgaris ◽  
Providencia Rettgeri ◽  
E Coli

Мета роботи — вивчити резистентність до антибіотиків бактеріальних збудників інфекцій сечових шляхів (ІСШ), виділених у пацієнтів урологічного стаціонару в м. Києві. Матеріали і методи. Досліджено 1612 штамів бактерій, виділених із сечі хворих з ІСШ (цистит, уретрит, пієлонефрит), госпіталізованих в урологічне відділення ДУ «Інститут урології НАМН України» у м. Києві протягом 2016 р. Серед пацієнтів переважали жінки — 1201 (74,5 %). Вік хворих становив від 17 до 74 років. Для збору даних використано медичну документацію лікарні. Мікробіологічні дослідження виконано у лабораторії мікробіології ДУ «Інститут урології НАМН України». Аналізували результати культурального дослідження зразків сечі, зібраних за наявності клінічних ознак ІСШ. Дослідження клінічного матеріалу та інтерпретацію отриманих результатів проводили загальноприйнятими методами. Вивчено чутливість уропатогенів до 31 антибіотика дискодифузійним методом відповідно до рекомендацій Інституту клінічних та лабораторних стандартів США (Clinical and Laboratory Standards Institute (CLSI)). Результати та обговорення. Аналіз мікробного спектра сечі виявив домінування серед уропатогенів штамів Escherichia coli (32,0 %), Enterococcus faecalis (19,5 %), Klebsiella pneumoniae (10,9 %), Staphylococcus epidermidis (8,9 %), S. haemolyticus (6,5 %) та Pseudomonas aeruginosa (6,4 %). Частка Enterococcus faecium, Enterobacter aerogenes і Streptococcus viridans становила відповідно 2,5, 2,2 і 1,6 %, Enterobacter cloacae, Klebsiella oxytoca, Acinetobacter baumannii, Proteus vulgaris та Providencia rettgeri — менше 1,0 %. У більшості випадків (69,7 %) мікроорганізми виділено у монокультурі, у решті випадків — у мікробних асоціа- ціях. Високу резистентність до тестованих антибіотиків виявили штами E. aerogenes (45,1 %), E. cloacae (45,7 %), E. faecium (40,9 %), E. faecalis (40,7 %), E. coli (39,9 %), P. aeruginosa (34,0 %), K. pneumoniae (28,6 %). Найбільш активними до уропатогенів були іміпенем (E. coli — 87,6 %, P. aeruginosa — 75,7 %, E. cloacae — 67,3 %, E. aerogenes — 72,6 %, K. pneumoniae — 93,2 %), меропенем (E. coli — 89,1 %, P. aeruginosa — 76,7 %, K. pneumoniae — 82,6 %), лефлоцин (E. coli — 74,5 %, ентерококи — 78,7 %, P. aeruginosa — 76,7 %, E. cloacae — 73,9 %, E. aerogenes — 80,4 %, K. pneumoniae — 83,5 %), амоксицилін/клавуланат (ентерококи — 84,6 %), фурагін (ентерококи — 82,6 %), цефоперазон (K. pneumoniae — 89,2 %, P. aeruginosa — 73,8 %), цефтріаксон (K. pneumoniae — 80,1 %). Висновки. Антибіотикорезистентність збудників ІСШ — важлива терапевтична проблема. Найбільшою активністю до уропатогенів характеризуються іміпенем, меропенем, лефлоцин, амоксицилін/ клавуланат, фурагін, цефоперазон, цефтріаксон, які можна розглядати як препарат вибору для призначення стартової терапії ІСШ. Необхідно здійснювати постійний моніторинг за резистентністю до дії антибіотиків. Політику використання антибіотиків у кожному стаціонарі слід визначати залежно від локальних даних щодо резистентності до протимікробних препаратів.

scholarly journals Applying ecological resistance and resilience to dissect bacterial antibiotic responses

2018 ◽  
Vol 4 (12) ◽  
pp. eaau1873 ◽  
Author(s):  
Hannah R. Meredith ◽  
Virgile Andreani ◽  
Helena R. Ma ◽  
Allison J. Lopatkin ◽  
Anna J. Lee ◽  
...  
Keyword(s):  
Microbial Communities ◽  
Antibiotic Treatment ◽  
Bacterial Pathogens ◽  
Ecological Systems ◽  
Essential Property ◽  
Short Term ◽  
Bacterial Response ◽  
Ecological Resistance ◽  
Combination Treatments ◽  
Lactam Antibiotic

An essential property of microbial communities is the ability to survive a disturbance. Survival can be achieved through resistance, the ability to absorb effects of a disturbance without a notable change, or resilience, the ability to recover after being perturbed by a disturbance. These concepts have long been applied to the analysis of ecological systems, although their interpretations are often subject to debate. Here, we show that this framework readily lends itself to the dissection of the bacterial response to antibiotic treatment, where both terms can be unambiguously defined. The ability to tolerate the antibiotic treatment in the short term corresponds to resistance, which primarily depends on traits associated with individual cells. In contrast, the ability to recover after being perturbed by an antibiotic corresponds to resilience, which primarily depends on traits associated with the population. This framework effectively reveals the phenotypic signatures of bacterial pathogens expressing extended-spectrum β-lactamases (ESBLs) when treated by a β-lactam antibiotic. Our analysis has implications for optimizing treatment of these pathogens using a combination of a β-lactam and a β-lactamase (Bla) inhibitor. In particular, our results underscore the need to dynamically optimize combination treatments based on the quantitative features of the bacterial response to the antibiotic or the Bla inhibitor.

The Impact of Colonization with Multidrug-Resistant Bacterial Pathogens (MRP) in Allogeneic Hematopoietic Cell Transplantation - Clearance of the MRP Is Pivotal for Survival

Blood ◽  
2016 ◽  
Vol 128 (22) ◽  
pp. 3421-3421
Author(s):  
Daniela Heidenreich ◽  
Sebastian Kreil ◽  
Klaus-Peter Becker ◽  
Thomas Miethke ◽  
Wolf-Karsten Hofmann ◽  
...  
Keyword(s):  
Overall Survival ◽  
Cell Transplantation ◽  
Hematopoietic Cell Transplantation ◽  
Bacterial Pathogens ◽  
Enterobacter Cloacae ◽  
Multidrug Resistant ◽  
Hematopoietic Cell ◽  
Allogeneic Hematopoietic Cell Transplantation ◽  
Klebsiella Pneumonia

Abstract Multidrug-resistant bacterial pathogens (MRP) such as extended-spectrum beta-lactamase producing enterobacteriaceae (ESBL), vancomycin-resistant enterococci (VRE), methicillin-resistant Staphylococcus aureus (MRSA) and multi-resistant Pseudomonas aeruginosa (P. aeruginosa) are an emerging challenge in allogeneic hematopoietic cell transplantation (HCT). However, no comprehensive data are available on the prevalence of MRP, their impact on the outcome after HCT and on the probability to clear a MRP. It was the purpose of this study to systematically analyze the issue of MRP in HCT. PATIENTS AND METHODS: From 07/2010 to 12/2015 a total number of 121 (43 F; 78 M) consecutive patients who received the first allogeneic HCT at our institution were analyzed retrospectively. As baseline investigation before conditioning all patients underwent a comprehensive screening for MRP. Swabs from nose, throat, axilla, urethra and anus as well as samples from stool and urine were collected. During the course of transplantation surveillance cultures were performed weekly. In addition, routine microbiological investigations were done from blood, urine, swabs, stool or central venous catheters whenever clinically needed. In MRP colonized patients surveillance stool specimen were taken until the MRP was repeatedly non-detectable. Multidrug-resistant gram neg. bacteria were categorized as 4MRGN (resistant to cephalosporins, piperacillin, fluorochinolones and carbapenems) or as 3MRGN (resistant to 3 of these 4 antimicrobial drug groups). The primary endpoint of this analysis was day 100 non relapse mortality (NRM). Secondary endpoints were NRM and overall survival (OS) after 2 years. A further endpoint in MRP+ patients was the time to non-detectability of the MRP. RESULTS: The patient characteristics were as follows: Underlying diseases were AML (62), ALL (7), CML (8), MPN (5), lymphoma (9), MDS (25), and multiple myeloma (5). The conditioning regimen was myeloablative in 50, reduced intensity in 71 patients. Patients were transplanted with peripheral blood stem cells (105) or bone marrow (16) from matched siblings (28), matched unrelated (67), mismatched (15) or haploidentical donors (11). 33 patients (27%) were colonized by at least one MRP (MRP+ group) either at baseline (baseline MRP+ group, n=18, 15%) or at any other time point until day 100 post HCT. The 33 MRP+ group patients were colonized by 42 MRP (baseline MRP+ group: 19 MRP). Detected MRP were 3MRGN E. coli or Klebsiella pneumonia (17), 4MRGN (9) or 3MRGN (2) P. aeruginosa, multi-resistant Stenotrophomonas maltophilia (2), 3MRGN Citrobacter freundii (1), 3MRGN Acinetobacter baumanii (1), 4MRGN Enterobacter cloacae (2), VRE (7) and MRSA (1). Out of these 33 patients 12 (36%) developed an infection with an MRP after HCT: septicemia (n=9), pneumonia caused either by 3MRGN Klebsiella (n=1) or by 4MRGN P. aeruginosa (n=1) and urinary tract infection by 4MRGN Enterobacter cloacae (n=1). 5 patients died MRP related due to septicemia (4MRGN P. aeruginosa n=4, VRE n=1). However, day 100 and 2-year NRM of MRP colonized vs non-colonized patients were essentially the same: 15 and 21% vs 15 and 24%, respectively. Even for the baseline MRP+ group there was no significant difference of NRM: 17 and 29% vs 15 and 22%. Overall survival was also not impaired in the MRP+ group 2 years post HCT (median follow up 32.4 months, range 7.5 to 71.4 months): MRP colonized versus non-colonized patients: 60 vs 55% (baseline MRP+ group 54 vs 58%). Out of the 33 MRP+ group patients 21 patients were able to clear the MRP. On day 100 after HCT 36% of patients had been able to clear the MRP. Median time to non-detectability of the MRP was 6.3 months. In 12 patients the MRP did not disappear until the end of the observation period or death (median follow up 15 months). There was a highly significant (p<0.0001) survival difference between patients who cleared the MRP vs those with MRP persistence. Whereas 17 out of 21 (81%) patients who cleared the MRP survived, only 2 out of 12 patients with MRP persistence stayed alive (median survival 6.6 months). Day 100 NRM was 4 vs 42% (p=0.0023). CONCLUSIONS: Since colonization by MRP had no neg. impact on the outcome in our cohort HCT of MRP colonized patients is feasible. However, the outcome of patients who do not clear their MRP is dismal. In order to increase the probability to clear the MRP we suggest to review the use of antibiotics in MRP colonized patients critically. Disclosures No relevant conflicts of interest to declare.

The differential importance of mutations within AmpD in cephalosporin resistance of Enterobacter aerogenes and Enterobacter cloacae

2016 ◽  
Vol 48 (5) ◽  
pp. 555-558 ◽  
Author(s):  
Baharak Babouee Flury ◽  
Matthew J. Ellington ◽  
Katie L. Hopkins ◽  
Jane F. Turton ◽  
Michel Doumith ◽  
...  
Keyword(s):  
Enterobacter Aerogenes ◽  
Enterobacter Cloacae ◽  
Cephalosporin Resistance

scholarly journals Draft Genome Assemblies of Enterobacter aerogenes CDC 6003-71, Enterobacter cloacae CDC 442-68, and Pantoea agglomerans UA 0804-01

2014 ◽  
Vol 2 (5) ◽  
Author(s):  
T. D. Minogue ◽  
H. E. Daligault ◽  
K. W. Davenport ◽  
K. A. Bishop-Lilly ◽  
D. C. Bruce ◽  
...  
Keyword(s):  
Draft Genome ◽  
Enterobacter Aerogenes ◽  
Enterobacter Cloacae ◽  
Pantoea Agglomerans ◽  
Genome Assemblies

scholarly journals Infecciones por Enterobacter y Enterococcus resistentes asociadas a la atención en salud en Hispanoamérica 2002-2017

2020 ◽  
Vol 24 (3) ◽  
pp. 221-232
Author(s):  
Lesly Y. Moreno-Rovira ◽  
Marly T. Tamayo-Quintero ◽  
Natalia Amariles-Tamayo ◽  
Erika F. Garrido-Zea
Keyword(s):  
Enterococcus Faecalis ◽  
Enterococcus Faecium ◽  
Enterobacter Aerogenes ◽  
Enterobacter Cloacae

Introducción. La aparición de bacterias resistentes es un fenómeno natural que ha sido potencializado por el uso inapropiado de antibióticos y por la automedicación, lo cual ha contribuido con la aparición de cepas resistentes de Enterobacter y Enterococcus, ocasionando a su vez un incremento significativo en las infecciones asociadas a la atención en salud (IAAS), a las tasas de morbimortalidad y a los costos del sistema de salud. El objetivo fue analizar las IAAS, enfatizando en bacteriemia, infección del tracto urinario, endocarditis y meningitis, causadas por cepas de Enterobacter y Enterococcus resistentes a los antimicrobianos, en Hispanoamérica, durante los años 2002 a 2017. Materiales y métodos. Se realizó una búsqueda bibliográfica en Elsevier y SciELO, empleando términos Descriptores en Ciencias de la Salud (DeCS). Se analizaron 26 artículos de revisión y originales que cumplían con los criterios de inclusión y exclusión. Resultados. La principal infección fue la bacteriemia en un 30,4%, y es de resaltar la escasa información encontrada acerca de endocarditis y meningitis. Enterococcus faecalis y Enterococcus faecium representaron el 90% de los aislamientos clínicos. La resistencia a los antibióticos continúa en ascenso constante, especialmente por parte de Enterococcus faecalis. Conclusión. Las IAAS producidas por microorganismos como Enterococcus faecalis, Enterococcus faecium, Enterobacter cloacae y Enterobacter aerogenes son frecuentes, aunque se cuenta con una cantidad moderada de información. El abordaje conceptual de esta problemática en el área de salud, puede ser una herramienta idónea para su control.

scholarly journals Pola bakteri aerob yang berpotensi menyebabkan infeksi nosokomial di kamar bersalin RSUP Prof. Dr. R. D. Kandou Manado

2016 ◽  
Vol 4 (2) ◽  
Author(s):  
Gabriella F.A. Kambey ◽  
Heriyannis Homenta ◽  
John Porutu'o
Keyword(s):  
Nosocomial Infection ◽  
Nosocomial Infections ◽  
Enterobacter Aerogenes ◽  
Enterobacter Cloacae ◽  
The Body ◽  
Delivery Room ◽  
Hospital Environment ◽  
Aerobic Bacteria ◽  
Hospital Workers ◽  
Serratia Liquefaciens

Abstract: Infection acquired in the hospital (nosocomial infection) is defined as an infection that does not exist or is in the incubation period at the time of hospital admission and is associated with health care. Nosocomial infection occurs as a result of interaction of several factors, among others, the types of microbes in the hospital environment, nursing actions that allow microbial intervention into the body through the skin and mucous membranes, interactions among patients, hospital workers, equipment and the environment as well as an increase of opportunistic microbial resistance. This study aimed to determine the pattern of aerobic bacteria that were potential to cause nosocomial infections in the delivery room of Prof. Dr. R. D. Kandou Hospital Manado. This was a prospective descriptive study. Samples were obtained from walls, floors, medical equipment, and the air in the delivery room at Prof. Dr. R. D. Kandou Manado. The results showed that of 22 samples, there were several types of bacteria as follows: Bacillus subtillis (40.1%), Enterobacter aerogenes (18.2%), Gram-negative cocci (18.2%), Serratia liquefaciens (13.6%), and Enterobacter cloacae (9.9%). Conclusion: The most common type of aerobic bacteria in the delivery room of Prof. Dr. R. D. Kandou Hospital Manado was Bacillus subtillis. Keywords: delivery room, nosocomial infections, aerobic bacteria Abstrak: Infeksi yang didapat di rumah sakit (nosokomial) didefinisikan sebagai infeksi yang belum ada atau sedang dalam masa inkubasi pada saat masuk rumah sakit dan infeksi yang berkaitan dengan perawatan kesehatan. Infeksi nosokomial terjadi sebagai akibat interaksi oleh beberapa faktor yaitu antara lain: adanya jenis-jenis mikroba di lingkungan rumah sakit, tindakan keperawatan yang memungkinkan mikroba intervensi ke dalam tubuh melalui kulit dan membran mukosa, interaksi antara pasien, pekerja rumah sakit, peralatan dan lingkungan, serta peningkatan resistensi mikroba oportunistik. Penelitian ini bertujuan untuk mengetahui pola bakteri aerob di dinding, lantai, peralatan medis, dan udara di kamar bersalin RSUP Prof. Dr. R. D. Kandou Manado. Jenis penelitian ini deskriptif dengan pendekatan prospektif. Sampel penelitian diambil dari dinding, lantai, peralatan medis dan udara di kamar bersalin RSUP Prof. Dr. R. D. Kandou Manado. Hasil penelitian dari 22 sampel mendapatkan bakteri yang tumbuh ialah Basillus subtillis (40,1%), Enterobacter aerogenes (18,2%), kokus Gram negatif (18,2%), Serratia liquefaciens (13,6%), dan Enterobacter cloacae (9,9%). Simpulan: Bakteri aerob di kamar bersalin Prof. Dr. R. D. Kandou Manado yang terbanyak ialah Bacillus subtillis. Kata kunci: kamar bersalin, infeksi nosokomial, bakteri aerob

scholarly journals Fatores de risco e perfil do uso de antimicrobianos entre pacientes com infecção no trato urinário em uma unidade de terapia intensiva

2021 ◽  
Vol 10 (3) ◽  
pp. e43910313516
Author(s):  
Lucas Harassim ◽  
Olibio Lopes Fiebig da Silva ◽  
Luiz Felipe Soares Pinheiro ◽  
Elber José Assaiante dos Santos ◽  
Cláudio Daniel Cerdeira ◽  
...  
Keyword(s):  
Escherichia Coli ◽  
Staphylococcus Aureus ◽  
Pseudomonas Aeruginosa ◽  
Klebsiella Oxytoca ◽  
Enterobacter Aerogenes ◽  
Enterobacter Cloacae ◽  
Citrobacter Freundii ◽  
Providencia Rettgeri ◽  
E Coli ◽  
Terapia Intensiva

A Infecção no Trato Urinário (ITU) acometendo pacientes em Unidades de Terapia Intensiva (UTIs) é uma realidade preocupante, agravada pelo uso irracional de antimicrobianos e a alarmante multirresistência em microrganismos. Nós avaliamos o nível de assertividade quanto ao uso de antimicrobianos durante à antibioticoterapia empírica (ATE), em pacientes diagnosticados com ITU, comparando tal tratamento farmacológico empírico e o realizado após o antibiograma (antibioticoterapia direcionada), além disto, estimamos a prevalência dos agentes etiológicos e analisamos os fatores de risco associados. Este é um estudo observacional e transversal, realizado em 2015, no qual foram avaliados pacientes de ambos os sexos e todas as idades apresentando ITU e submetidos à antibioticoterapia, internados em uma UTI de um hospital no sul de Minas Gerais, Brasil. Dos 49 pacientes avaliados (28 mulheres [M] e 21 homens [H]), a média de idade foi 55±19 anos (IC(95) 49-61) e a faixa etária ≥70 anos foi a predominante. Quatorze diferentes microrganismos foram causadores de ITUs, sendo que 28,3% (IC(95%) 16,2-40,4) dos isolados clínicos tiveram Escherichia coli como o agente etiológico (33,3% H e 28,6% M); 18,9% (IC(95%) 8,3-29,4) Acinetobacter baumannii (33,3% H e 10,7% M); 15,1% (IC(95%) 5,5-24,7) Klebsiella pneumoniae (19% H e 14,3% M); 11,3% Pseudomonas aeruginosa (9,5% H e 14,3% M); 5,7% Enterobacter aerogenes (14,3% H); 3,8% Klebsiella oxytoca; 3,8% Staphylococcus aureus (7,1% M); e 1,9% para cada um dos seguintes microrganismos: Enterococcus faecalis (4,8% H); Proteus mirabilis (3,6% M); Enterobacter cloacae (3,6% M); Providencia rettgeri (4,8% H); Citrobacter koseri (3,6% M); Citrobacter freundii (3,6% M); e Fungos leveduriformes (4,8% H). As prevalências de ITUs causadas por A. baumannii e P. aeruginosa foram influenciadas pelo sexo (χ² com p<0,001). No sexo masculino, houve correlações positivas “substanciais” entre o aumento da idade (em anos) e a prevalência de ITU causada por E. coli (r = 0,69) ou entre idades menos avançadas e a prevalência de ITU causada por A. baumannii (r = -0,7). No sexo feminino, houve uma correlação positiva “extremamente forte” entre o aumento da idade e a prevalência de ITU causada por E. coli (r = 0,94; IC(95) 0,66-0,99; p<0,0014). Os antibióticos mais utilizados de forma empírica (ATE) foram: Ciprofloxacina (14,3% IC(95%) 4,7-24,1), Cefepima (14,3%) e Vancomicina (10%), e após o antibiograma (antibioticoterapia direcionada): Ceftazidima (16,3% IC(95%) 6-26,7), Ciprofloxacina (14,3% IC(95%) 4,5-24,1), Polimixina B (10,2%), Imipenem (10,2%) e Ampicilina + Sulbac. (8,2%). Em 20% dos casos, as terapias empíricas (ATE) foram consideradas “inapropriadas/não acertadas”. Contudo, também devemos ter ciência da necessidade clínica e quanto ao imediatismo para o tratamento de uma ITU em UTI, uma vez que a doença pode ser fatal se uma terapia não for instituída, portanto, nós aconselhamos avaliações mais minuciosas, tanto da racionalidade do uso de antibióticos, quanto dos fatores de risco para o desenvolvimento de ITUs em UTIs.

scholarly journals Profil Penggunaan Antibiotik dan Peta Kuman pada Pasien Gangren Diabetes Melitus di Sebuah RSUD di Kabupaten Gresik

2020 ◽  
Vol 3 (2) ◽  
pp. 96
Author(s):  
Isna Romadhona ◽  
Fauna Herawati ◽  
Rika Yulia
Keyword(s):  
Escherichia Coli ◽  
Staphylococcus Aureus ◽  
Pseudomonas Aeruginosa ◽  
Klebsiella Pneumoniae ◽  
Acinetobacter Baumannii ◽  
Proteus Mirabilis ◽  
Enterobacter Aerogenes ◽  
Enterobacter Cloacae ◽  
Proteus Vulgaris ◽  
Diabetes Melitus

Antibiotik merupakan obat yang digunakan untuk mengatasi dan mencegah infeksi bakteri. Penggunaan antibiotik yang tidak tepat dapat menimbulkan berbagai masalah, diantaranya pengobatan akan lebih mahal dan juga risiko terjadinya resistensi bakteri terhadap antibiotik. Penelitian ini bertujuan untuk mengetahui profil penggunaan antibiotik dan profil peta kuman pada pasien gangren diabetes melitus di sebuah RSUD di Kabupaten Gresik serta untuk mengetahui kesesuaian penggunaan antibiotik dengan mengacu pada Permenkes Republik Indonesia No. 2406/Menkes/PER/XII/2011. Data penggunaan antibiotik diperoleh dari catatan Rekam Medis pada periode Januari – November 2017. Data penggunaan antibiotik dihitung dengan menggunakan rumus DDD/100 pasien-hari rawat. Hasil perhitungan DDD/100 pasien-hari rawat menunjukkan hasil sebesar 470,11 DDD/100 pasien-hari rawat. Peta kuman pada pasien gangren, melaporkan adanya bakteri Enterobacter cloacae 24%, Escherichia coli 18%, Staphylococcus aureus 15%, Acinetobacter baumannii 9%, Pseudomonas aeruginosa 6%, Citrobacter youngae 6%, Enterobacter aerogenes 6%, Proteus vulgaris 6%, Staphylococcus schleiferi 6%, Klebsiella pneumoniae 3%, dan Proteus mirabilis 3% . Penggunaan antibiotik seftriakson dan metronidazol pada pasien gangren diabetes melitus di sebuah RSUD di Kabupaten Gresik pada periode Januari – November 2017 telah sesuai dengan pedoman penggunaan antibiotik berdasarkan Permenkes Republik Indonesia No. 2406/Menkes/PER/ XII/2011, yaitu antibiotik golongan sefalosporin generasi III yang lebih aktif terhadap Enterobacteriaceae dan antibiotik golongan nitroimidazol yang dapat mengobati infeksi bakteri basil anerob Gram-Negatif.

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