Subject(s)
Biofilms/growth & development , Gram-Positive Bacteria/physiology , Gram-Positive Bacterial Infections/microbiology , Urinary Tract Infections/microbiology , Aged , Aged, 80 and over , Bacteriological Techniques , Cross Infection/microbiology , Female , Gram-Positive Bacteria/isolation & purification , Humans , Middle Aged , Tertiary Care CentersABSTRACT
From January 1998 to December 2001, 176 cases of Citrobacter bacteremia occurred of which repeat isolation was possible in 48 cases. Of 48 isolates, 79.1% were C. diversus and 20.9% C. freundii. Citrobacter bacteremia was polymicrobial in 46.1% cases, and maximum number of cases (54.1%) occurred in the age group less than 10 years. Portal of entry was unknown (42.3%), respiratory tract (20.9%), gastrointestinal tract (15.3%) and urinary tract 15.3%. C. freundii isolates were relatively more resistant than C. diversus against 10 tested antimicrobial agents, while 79.1% isolates were multiresistant. Sensitivity based on MIC was highest for ceftizoxime, ciprofloxacin and cefotaxime. Overall mortality of Citrobacter bacteremia was seen in 56% of cases. Therefore greater caution is required in selection of antibiotic therapy in order to avoid selection of strains and treatment failure.
Subject(s)
Anti-Bacterial Agents/pharmacology , Bacteremia/epidemiology , Citrobacter/drug effects , Citrobacter/isolation & purification , Enterobacteriaceae Infections/epidemiology , Adolescent , Adult , Age Factors , Anti-Bacterial Agents/therapeutic use , Bacteremia/drug therapy , Bacteremia/mortality , Child , Cross Infection , Drug Resistance, Bacterial , Drug Resistance, Multiple, Bacterial , Enterobacteriaceae Infections/drug therapy , Enterobacteriaceae Infections/mortality , Female , Humans , Male , Microbial Sensitivity Tests , Middle AgedABSTRACT
OBJECTIVES: To study the incidence, antimicrobial susceptibility pattern, age and sex distribution, mortality and prognostic factors in cases of Enterobacter bacteremia. METHODS: A total of 18,745 indoor patients with suspected bacteremia were included in study. Enterobacter spp were identified and speciated using standard protocols. Antimicrobial susceptibility testing was done using Stoke's disc diffusion method and minimum inhibitory concentration (MIC) was determined by agar dilution method as recommended by NCCLS. RESULTS: Enterobacter spp ranking sixth was responsible for 4.6% of total group of significant bacteremias. The species most commonly causing bacteremia was E. cloacae (61.8%). The bacteremia was unimicrobial in 85.1% and part of a polymicrobial bacteremia in 14.8%. Portal of entry in decreasing order of frequency were unknown, respiratory tract, urinary tract and surgical wound. The most common clinical finding was fever (97.2%). Of Enterobacter isolates 72.9% were multiresistant to three or more antimicrobial agents. Overall mortality was 51.1%. CONCLUSION: Enterobacter spp are becoming increasingly important nosocomial pathogens. To prevent further emergence of multidrug resistance it may beprudent to avoid third generation cephalosporins and instead combination therapy may be used.
