Optimum management of Citrobacter koseri infection

Abstract

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. 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. We reviewed antimicrobial agents used for C. koseri infections in this review.

Keywords::

• Citrobacter koseri
• infection
• management
• treatment

Financial & competing interests disclosure

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

No writing assistance was utilized in the production of this manuscript.

Key issues

• The genus Citrobacter belongs to the family of Enterobacteriaceae and comprises 11 different species.

• The majority of clinical infections are associated with Citrobacter koseri and Citrobacter freundii.

• Citrobacter infections are mainly associated with health care.

• C. koseri accounts for a variable but significant proportion of Citrobacter infections (ranging from about 19.8 to 90.2%), the most frequent localization being the urinary tract, respiratory tract, blood stream and central nervous system.

• The mortality rate of hospitalized patients with Citrobacter infections is ranged from 10 to 56% and, it is associated with antibiotic resistance pattern rather than Citrobacter spp.

• C. koseri mandates antimicrobial therapy based on anti-bacterial susceptibility pattern and infection side.

• C. koseri is naturally resistant to aminopenicillins and carboxypenicillins.

• C. koseri gradually gains antibiotic resistance over time against various types of antibiotics by means of chromosomal and plasmid-mediated determinants genes.

• Quinolones and carbapenems are rational option for the treatment of susceptible C. koseri strains.

• Colistin and tigecycline should be reserved for multi-drug-resistant isolates.