Low virulent Citrobacter koseri can cause life threatening infections. Neonates and other immunocompromised patients are particularly susceptible to infection from C. koseri. Any infection due to C. koseri mandates antimicrobial therapy based on the sensitivity of the pathogen microorganism.
Can Citrobacter koseri cause urinary tract infections?
Citrobacter freundii and Citrobacter koseri. Citrobacter freundii and Citrobacter koseri can cause urinary tract infections, and are found in wound, respiratory, meningitis, and sepsis. They can cause healthcare-associated infections, especially in pediatric and immunocompromised patients [41].
What is the mortality and morbidity of Citrobacter infections?
The leading three species causing human infections are C. freundii, C. koseri, and C. braakii. Among all the Citrobacter infections, around one-third to one-half are polymobic (54). The overall mortality rate of Citrobacter infections are 2.0% to 17.7% (15, 34, 54).
Can Citrobacter freundii cause urinary tract infections?
Amitava Dasgupta, in Microbiology and Molecular Diagnosis in Pathology, 2017 Citrobacter freundii and Citrobacter koseri can cause urinary tract infections, and are found in wound, respiratory, meningitis, and sepsis.
What is Citrobacter infection?
Citrobacter: An emerging health care associated urinary pathogen. It is known to cause health care associated infections of the urinary tract, respiratory tract, blood, and other normally sterile sites in the body. The chief cause is a weak and attenuated immune system and functioning of the body.
Is Citrobacter koseri serious?
1 Unlike Citrobacter freundii, which is usually associated with hepatobiliary tract infections, Citrobacter koseri has a strong propensity to cause meningitis and brain abscess in neonatal and infants, with higher morbidity and mortality rates.
Is Citrobacter koseri curable?
Brain abscesses caused by C. koseri have been reported to be cured by medical therapy alone (7, 36, 43). However, combination of antimicrobial therapy and surgical drainage/aspiration, if feasible, would be the preferred therapy.
How do you get Citrobacter koseri?
The transmission of C. koseri could be vertical from mother to fetus (local vaginal infection, rupture of the membranes, chorioamniotis may occur between the seventh and 11th day prior to delivery) and other sources can be horizontal nosocomial transmission by asymptomatic nursery staff.
Is Citrobacter koseri in urine dangerous?
koseri has been associated with cases of neonatal meningitis and brain abscess and C. freundii with gastroenteritis, neonatal meningitis, and septicemia. [3] It is known to cause health care associated infections of the urinary tract, respiratory tract, blood, and other normally sterile sites in the body.
How common is Citrobacter koseri UTI?
Citrobacter isolates are reported to be the third most common organisms causing UTI in hospitalized patients after Escherichia More Details coli and Klebsiella species accounting for 9.4% of all isolates.
How do you get rid of Citrobacter?
Treating Citrobacter Infections. A doctor will tell you to take antibiotics. A naturopath, functional medicine practitioner or holistic doctor might tell you to take grapefruit seed extract or oregano oil. Many times this kill focused approach may clear up your bacterial infection in the short term.
How do I get rid of Citrobacter koseri?
koseri mandates antimicrobial therapy based on the sensitivity of the pathogen microorganism. Various types of antibiotics, including aminoglycosides carbapenems, cephalosporins, chloramphenicol and quinolones, are used for the treatment of C. koseri infections.
What disease does Citrobacter cause?
Citrobacter normally cause urinary tract infections, blood stream infections, intra abdominal sepsis, brain abscesses, and pneumonia and other neonatal infection 6, such as meningitis, neonatal sepsis, joint infection or general bacteremia 7.
What is the best antibiotic to treat Citrobacter koseri?
Based on favorable sensitivity data, penetration into neutrophils and the CNS, and favorable toxicity profiles, ciprofloxacin and meropenem would appear to be the most appropriate antibiotic treatment options for systemic infection or meningitis caused by C. koseri.
Can Citrobacter koseri cause pneumonia?
Citrobacter koseri, formerly known as Citrobacter diversus, is a facultative anaerobe and motile, gram-negative bacillus of the family Enterobacteriaceae. Citrobacter spp. have been implicated in a wide array of disease processes, including urinary tract infections, pneumonia, and bacteremia.
Is Citrobacter found in stool?
Citrobacter freundii is isolated from human and animal feces, as well as from extraintestinal specimens. It is also commonly found in soil water and food.
Can Citrobacter cause diarrhea?
Citrobacter freundii is an infrequent but established cause of diarrhea in humans.
Can Citrobacter be cured?
Citrobacter freundii infection is usually treated with antibiotics like fluoroquinolones, carbapenems and cephalosporins. The treatment plan depends up on the vulnerability of the microbe to the antibiotics and the site of the infection.
What is the best antibiotic for Citrobacter koseri?
Conclusions: Ciprofloxacin and meropenem should be considered antibiotic treatment options for systemic infection or meningitis caused by C. koseri.
What disease does Citrobacter cause?
Citrobacter normally cause urinary tract infections, blood stream infections, intra abdominal sepsis, brain abscesses, and pneumonia and other neonatal infection 6, such as meningitis, neonatal sepsis, joint infection or general bacteremia 7.
What causes Citrobacter infection?
Environments known to contain Citrobacter Citrobacter are found in a variety of environmental sources, including soil and water, and in the human intestines. They are rarely the primary source of illness, though some strains can cause infections of the urinary tract, sepsis, and infant meningitis.
Where is C. koseri found?
C. koseri may be identified in the walls of congested vessels, presence of the cavities resulting from the infection do not develop well-formed fibrotic wall.
How many neonates die from C. koseri?
The prognosis of the C. koseri infection is 20 to 30% of neonates die, and 75% of survivors have significant neurologic damage such as complex hydrocephalus, neurologic deficits, mental delay, and epilepsy.
What is the early stage of C. koseri?
Early and massive tissue necrosis is a specific feature of C. koseri brain infection. The early stage of the disease predominates in the white matter, causing cerebritis; the later stage is marked with necrotic cavities in multiple locations.
Does C. koseri survive in phagolysozomal fusion?
Furthermore, it survives in phagolysozomal fusion and replicates within macrophages, which may contribute to the establishment of chronic abscesses.
Does C. koseri grow well?
In samples collected from cerebrospinal fluid, C. koseri grows well on an any ordinary medium; they produce unpigmented, colorless mucoid colonies. If incubated for 24 hours in other media such as indole, citrate, and adonitol, C.koseri will be positive, hydrogen sulfide negative in Kligers’ iron agar, negative results in lactose, salicin, and sucrose broth as well. .
Can meningitis cause cerebritis?
Occasionally, it causes meningitis, but it can cause sepsis, ventriculitis, and cerebritis with 80% frequent multiple brain abscesses in low-birth-weight, immunocompromised neonates; rare cases have been reported in older children and adults, most of whom have underlying diseases.
Is Citrobacter koseri a Gram negative bacillus?
Citrobacter koseri is a Gram-negative, non-spore-forming bacillus. It is a facultative anaerobe capable of aerobic respiration. It is motile via peritrichous flagella. It is a member of the family of Enterobacteriaceae. The members of this family are the part of the normal flora of human and animal digestive tracts. [1] C. koseri may act as an opportunistic pathogen in a variety of human infections.
What antibiotics are used for C. koseri?
Various types of antibiotics, including aminoglycosides carbapenems, cephalosporins, chloramphenicol and quinolones, are used for the treatment of C. koseri infections. The rational choice of antimicrobial therapy for Citrobacter infections is a challenge for clinicians because there is a sustained increase in antibacterial resistance.
Can neonates get C. koseri?
Neonates and other immunocompromised patients are particularly susceptible to infection from C. koseri. Any infection due to C. koseri mandates antimicrobial therapy based on the sensitivity of the pathogen microorganism. Various …. Low virulent Citrobacter koseri can cause life threatening infections. Neonates and other immunocompromised patients ...
Can Citrobacter Koseri cause infection?
Low virulent Citrobacter koseri can cause life threatening infections. Neonates and other immunocompromised patients are particularly susceptible to infection from C. koseri. Any infection due to C. koseri mandates antimicrobial therapy based on the sensitivity of the pathogen microorganism.
What page is antibiotic resistance in Citrobacterspp. isolated from urinary tract infection?
See the article "Antibiotic resistance in Citrobacterspp. isolated from urinary tract infection" on page 312.
What is the third most common urinary pathogen?
The authors have conducted a retrospective study and have reported Citrobacterspp . as the third most common urinary pathogen accounting for 9.4% of the total isolates. The isolation of this organism was associated with catheterization, genitourinary instrumentation, or obstructive uropathy. Also, the age group most affected was that of elderly hospitalized patients, especially males. Their finding emphasizes the role of this organism as a common health care associated pathogen. Recently, a study conducted in Nepal also reported Citrobacterspp. as the second most common urinary pathogen in their study.[4]
Is Citrobacterspp a nosocomial?
Although Citrobacterspp. are less commonly isolated, they are emerging as a common nosocomial multidrug-resistant pathogen, especially in developing countries. UTI caused by Citrobacterspp. have been seen in 12% patients in 1961, and since then, its prevalence has been increasing.[5] Invasive procedures like catheterization or genitourinary instrumentation seem to assist the organism in colonization and infection of urinary tract. Another matter of concern is the emergence of multidrug-resistant Citrobacterspp., resulting in reduced therapeutic options which further complicate the situation. The author also reported that most of the isolates were resistant to penicillins, cephalosporins, aminoglycosides, and fluoroquinolones, which are the commonly prescribed drugs in UTI. Resistance to many groups of antibiotics has been observed and many mechanisms of drug resistance have been demonstrated in Citrobacterspp. In a study concluded by Shobha et al., Citrobacterspp. was the third most common urinary pathogen and 30% of the isolates were extended spectrum beta lactamase (ESBL) producers.[6] Meher Rizvi et al. reported that 62.2% of Citrobacterisolates were producing ESBL.[7] High level carbapenem resistance was also reported in C. freundiidue to combination of Klebsiella pneumoniaecarbapenemase-2 (KPC-2) production and decreased porin expression.[8] Carbapenems are important antibiotics for the treatment of health care associated infections and have a special role in treating infection with ESBL-producing organisms. The emergence and spread of resistance to carbapenems will end all the treatment options available for treating multidrug-resistant pathogens.
Is C. koseriis a gram negative rod?
C. koseriis a gram-negative, non-lactose fermenting rod that is often part of normal human flora. It causes infections almost exclusively in neonates and infants—primarily meningitis—and in immune-compromised hosts.4In the adult patient, the urinary tract is one of the most common sites of infection by Citrobacter.
Can a koseriurinary tract infection cause severe complications?
C. koseriurinary tract infections are relatively uncommon, but they do have the potential for severe complications. We recommend early treatment of patients with C. koseriurinary tract infections, especially in the setting of nephrolithiasis and/or atypical urinary tracts to avoid serious complications and systemic illness.
What are the risks of acquiring Citrobacter?
Two groups of patients are at risk of acquiring Citrobacter infections. The first one is neonates, who may develop sepsis and meningitis (usually less than 2 months of age) and have a propensity for development of brain abscesses. C. koseri can cause an unusually severe form of neonatal meningitis, associated with necrotizing encephalitis and brain abscesses ( 14, 21, 33 ). The second group is debilitated, aged (≥ 65years) or immunocompromised patients. Like other Enterobacteriaceae, Citrobacter can cause a wide spectrum of infections in humans, such as infections in the urinary tract, respiratory tract, wounds, bone, peritoneum, endocardium, meninges, and bloodstream ( 38 ). Among the various sites of infection, the urinary tract is the most common, followed by the abdomen, skin/soft tissues (including surgical site infection), and pneumonia ( 54 ). Among 1441 nosocomial Citrobacter infection patients, 812 had urinary tract infection, 321 had surgical wound infection, 226 had pneumonia, and 82 had bloodstream infection. Citrobacter infection is not uncommon, and some authors have reported an increase in the incidence of Citrobacter infections ( 55 ). The leading three species causing human infections are C. freundii, C. koseri, and C. braakii. Among all the Citrobacter infections, around one-third to one-half are polymobic ( 54 ). The overall mortality rate of Citrobacter infections are 2.0% to 17.7% ( 15, 34, 54 ).
How to prevent Citrobacter infection?
Since several nosocomial outbreaks of Citrobacter infections have been reported and the sources of the organisms have been found to be the gastrointestinal tracts or hands of hospital staff members, infection control measures to prevent person-to-person transmission, such as hand washing, are the most important measures to prevent Citrobacter infection. As to the sporadic reports of vertical transmission from mother to child, there is no good recommendation to prevent the transmission. Good habits of hygiene probably may prevent transmission from environmental sources or carrier of family members.
What are the different types of Citrobacter?
Citrobacter species are straight, facultative anaerobic, Gram-negative bacilli and are typically motile by means of peritrichous flagellae. This genus was proposed in 1932 by Werkman and Gillen ( 61 ). Before 1993, only three species, Citrobacter freundii, Citrobacter koseri ( Citrobacter diversus ), and Citrobacter amalonaticus, were recognized. C. freundii is the type species in this genus, and the later two species have been called other names. C. koseri was accepted to replace the name C. diversus by the Judicial Commission of the International Committee on Systematic Bacteriology in 1993 ( 30 ). In the same year, Brenner et al. classified Citrobacter into 11 genomospecies by DNA hybridization: C.freundii, C.koseri, C. amalonaticus, C. farmeri, C. youngae, C. braakii, C. werkmanii, C. sedlakii, and unnamed genomospecies 9, 10 and 11 ( 8 ). Later, genomospecies 9, 10 and 11 were named as C. rodentium, C. gillenii, and C. murliniae ( 9, 56 ).
What is the second group of Citrobacter?
The second group is debilitated, aged (≥ 65years) or immunocompromised patients. Like other Enterobacteriaceae, Citrobacter can cause a wide spectrum of infections in humans, such as infections in the urinary tract, respiratory tract, wounds, bone, peritoneum, endocardium, meninges, and bloodstream ( 38 ).
Where are Citrobacter species found?
EPIDEMIOLOGY. Citrobacter species are commonly found in water, soil, food, and the intestinal tracts of animals and humans. Many Citrobacter infections are nosocomially acquired; however, they can also be community acquired. A large surveillance study demonstrated that 0.8% of Gram-negative infection was caused by Citrobacter spp. ( 27 ).
Is C. freundii resistant to antibiotics?
Different species of Citrobacter demonstrate different antimicrobial susceptibility profiles. C. freundii is generally much more resistant to antimicrobial agents than C. koseri ( C. diversus ). In the 1970s, isolates of C. koseri ( C. diversus) were usually resistant to ampicillin and carbenicillin but susceptible to cephalothin; in contrast, isolates of C. freundii were usually susceptible to ampicillin and carbenicillin but resistant to cephalothin ( 25, 29, 40 ). This characteristic was even proposed for use in species identification ( 59 ). However, C. freundii had become more resistant to many antimicrobial agents, including ampicillin and carbenicillin, so classification of species by antibiotic susceptibility pattern is no longer valid.
Can Citrobacter be identified?
Patients with Citrobacter infection can be identified and confirmed only by culture. Citrobacter species can grow in various culture medium. All species identified as Citrobacter ferment glucose with production of gas. With few exceptions the organisms are motile and utilize citrate.
Overview
Prognosis
The prognosis of the C. koseri infection is 20 to 30% of neonates die, and 75% of survivors have significant neurologic damage such as complex hydrocephalus, neurologic deficits, mental delay, and epilepsy.
Signs and symptoms
The neonates become very sick and present sepsis, meningitis, and cerebritis, seizures, apnea, and a bulging fontanelle. No evidence of stiff neck or high-grade fever is present.
Occasionally, it causes meningitis, but it can cause sepsis, ventriculitis, and cerebritis with 80% frequent multiple brain abscesses in low-birth-weight, immunocompromised neonates; rare cases have been reported in older children and adults, most of whom have underlying diseases.
Diagnosis
Early and massive tissue necrosis is a specific feature of C. koseri brain infection. The early stage of the disease predominates in the white matter, causing cerebritis; the later stage is marked with necrotic cavities in multiple locations. The cavities are initially square in shape and not tense, but when pus forms and collects in these cavities, they tend to become more rounded in shape; a persisting cavity leads to septated ventriculitis that may result in multicyctic hydrocephalus.
Treatment
A broad spectrum cephalosporin and meropenem are often used because of the good penetration into the central nervous system. If the response to the antibiotic is poor, the surgical aspiration of the collected pus reduces the mass effect and enhances the efficacy of the antibiotics.
Control
The most effective way to reduce transmission of organisms is regular handwashing.
External links
• "Citrobacter koseri". NCBI Taxonomy Browser. 545.
• Type strain of Citrobacter koseri at BacDive - the Bacterial Diversity Metadatabase