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논문 기본 정보

자료유형
학술저널
저자정보
저널정보
대한감염학회 Infection and Chemotherapy Infection and Chemotherapy 제51권 제1호
발행연도
2019.1
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1 - 9 (9page)

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Background Recently, Citrobacter freundii bacteremia outbreak in a neonatal intensive care unit has attracted public attention in Korea. However, Citrobacter bacteremia is uncommon and usually occurs in patients with underlying diseases such as malignancy and hepatobiliary diseases. Increase in resistance and emerging of multidrug resistance among Citrobacter species have gradually been reported. The aim of this study was to investigate the clinical characteristics and outcome of C. freundii and non-freundii bacteremia and antimicrobial susceptibility trends. Materials and Methods We reviewed the medical records of patients with Citrobacter bacteremia at St. Mary's Hospital, from 2007 to 2017. Results A total of 43 patients with a median age of 72 (24-93) years was identified and 90.7% of them had comorbidities. Twenty-nine (67.4%) patients had C. freundii bacteremia while 14 had non-freundii bacteremia (six of C. braakii, five of C. koseri, two of C. amalonaticus and one of C. youngae). A total of 26 (51.2%) patients had community-acquired infection and intra-abdominal infection including hepatobiliary tract was the most common portal of entry (24/43, 55.8%). Moreover, hepatobiliary tract was the leading primary site of nosocomial infection (9/17, 52.9%). Polymicrobial bacteremia was observed in 21 (48.8%) patients. The percentages of Citrobacter species susceptible to ampicillin, amikacin, aztreonam, cefazolin, cefoxitin, cefotaxime, cefepime, piperacillin-tazobactam, ciprofloxacin, and imipenem were 9.5%, 97.6%, 73.8%, 9.5%, 14.3%, 71.4%, 92.9%, 83.3%, 83.3% and 100%, respectively. The resistance rate did not increase during the study period. Of 39 patients treated with antibiotics, 36 (92.3%) received appropriate empirical antibiotics. Overall mortality was 18.6%. High Charlson comorbidity index and Pitt bacteremia score were significant risk factors for death in univariate analysis and showed trends in the multivariate analysis. No significant difference in clinical features and antimicrobial susceptibility rate was observed between C. freundii and non-freundii bacteremia. Conclusion Citrobacter bacteremia was predominant in the elderly with comorbidities, while no pediatric case was observed. Hepatobiliary tract is the leading primary focus of bacteremia both in community-acquired and nosocomial infection. The rate of susceptibility to antibiotics has not changed in the last 11 years.

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참고문헌 (30)

참고문헌 신청
Lavigne JP / 2007 / Clinical and molecular epidemiology of multidrug-resistant Citrobacter spp. infections in a French university hospital / Eur J Clin Microbiol Infect Dis 26:439~441 google schola Lipsky BA / 1980 / Citrobacter infections in humans : experience at the Seattle Veterans Administration Medical Center and a review of the literature / Rev Infect Dis 2:746~760 google schola Jones RN / 2000 / In vitro efficacy of six cephalosporins tested against Enterobacteriaceae isolated at 38 North American medical centres participating in the SENTRY Antimicrobial Surveillance Program, 1997-1998 / Int J Antimicrob Agents 15:111~118 google schola Samonis G / 2009 / Citrobacter infections in a general hospital : characteristics and outcomes / Eur J Clin Microbiol Infect Dis 28:61~68 google schola Kim BN / 2003 / Resistance to extended-spectrum cephalosporins and mortality in patients with Citrobacter freundii bacteremia / Infection 31:202~207 google schola

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