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Tollkuci E, Myers R. Citrobacter braakii CLABSI in a hematopoietic stem cell transplant patient. J Oncol Pharm Pract 2021; 27:1792-1794. [PMID: 33719724 DOI: 10.1177/10781552211001423] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
INTRODUCTION Citrobacter bacteria are gram-negative anaerobic bacilli commonly found in water, soil, food, and the intestinal tracts of animals and humans. Patients at highest risk of these nosocomial infections include neonates and adults who are ≥65 years of age, debilitated, or immunocompromised. Citrobacter braakii (C. braakii), specifically, has been reported to cause sepsis in immunocompromised patients. Herein, we describe a case of an allogeneic stem cell transplant (SCT) adult patient with C. braakii bloodstream infection. CASE REPORT We report our experience managing a central line-associated bloodstream infection (CLABSI) due to C. braakii in an allogeneic SCT patient.Management and Outcomes: Our patient was initially managed with cefepime. The central venous catheter (CVC) was removed. Blood cultures cleared 24 hours after antibiotic initiation. Therapy was transitioned to oral levofloxacin once susceptibilities resulted. DISCUSSION The course of this patient highlights the important relationship between an unusual pathogen, C. braakii, in an immunocompromised allogeneic SCT patient. In our case, the source of the bacteremia was most likely a CLABSI given the positive catheter tip cultures. Although this report describes the successful utilization of cefepime and levofloxacin in the treatment of C. braakii infection, caution should be exercised when choosing empiric antimicrobial therapy as AmpC resistance. This clinical scenario can aid health care providers in making informed treatment decisions when faced with patients diagnosed with this relatively uncommon pathogen. Further reports should be published to determine C. braakii bacteremia management in hematopoietic stem cell transplant patients.
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Affiliation(s)
- Eris Tollkuci
- College of Pharmacy, Rosalind Franklin University of Medicine and Science, North Chicago, IL, USA
| | - Rebecca Myers
- Division of Pharmacy, Rush University Medical Center, Chicago, IL, USA
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Novel IncR/IncP6 Hybrid Plasmid pCRE3-KPC Recovered from a Clinical KPC-2-Producing Citrobacter braakii Isolate. mSphere 2020; 5:5/2/e00891-19. [PMID: 32213624 PMCID: PMC7096625 DOI: 10.1128/msphere.00891-19] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
Reports of human-pathogenic C. braakii strains, especially of strains showing resistance to carbapenems, are rare. To the best of our knowledge, our results represent the first detection of carbapenemase gene blaKPC-2 in C. braakii strains. In addition, we have studied detailed genetic characteristics of the novel IncR/IncP6 hybrid plasmid pCRE3-KPC, which was isolated from a clinical multidrug-resistant Citrobacter braakii CRE3 strain. Our results may provide further insight into the horizontal transfer of multidrug resistance genes in bacteria and into the genomic diversity and molecular evolution of plasmids. Klebsiella pneumoniae carbapenemase (KPC)-producing Enterobacteriaceae have become widespread in hospitals and the environment. Here, we describe a blaKPC-2-carrying plasmid called pCRE3-KPC, which was recovered from a clinical multidrug-resistant Citrobacter braakii CRE3 strain in China. The complete nucleotide sequence of pCRE3-KPC was determined by combining MiSeq and MinION sequencing and then compared with those of three related plasmids. Plasmid conjugal transfer and electroporation tests, modified carbapenem inactivation method, and bacterial antimicrobial susceptibility test were carried out. We compared this plasmid with three related plasmids to verify that the backbone of pCRE3-KPC was composed of the backbones of the IncR plasmid and IncP6 plasmid. Further bioinformatics analysis showed that pCRE3-KPC carried two resistance-related regions (the blaKPC-2 gene cluster and the aacC2-tmrB-related region). The aacC2-tmrB-related region included two novel insertion sequences (ISCfr28 and ISCfr16). IMPORTANCE Reports of human-pathogenic C. braakii strains, especially of strains showing resistance to carbapenems, are rare. To the best of our knowledge, our results represent the first detection of carbapenemase gene blaKPC-2 in C. braakii strains. In addition, we have studied detailed genetic characteristics of the novel IncR/IncP6 hybrid plasmid pCRE3-KPC, which was isolated from a clinical multidrug-resistant Citrobacter braakii CRE3 strain. Our results may provide further insight into the horizontal transfer of multidrug resistance genes in bacteria and into the genomic diversity and molecular evolution of plasmids.
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Varriale L, Russo TP, Pace A, Mediatore S, Borrelli L, Santaniello A, Menna LF, Fioretti A, Dipineto L. Microbiological survey of sugar gliders (Petaurus breviceps) kept as pets in Italy. Lett Appl Microbiol 2020; 69:399-402. [PMID: 31618795 DOI: 10.1111/lam.13233] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2019] [Revised: 10/03/2019] [Accepted: 10/06/2019] [Indexed: 12/29/2022]
Abstract
The sugar glider (Petaurus breviceps) is a small, arboreal, nocturnal, gliding mammalian possum belonging to the marsupial infraclass. Exotic marsupials, including sugar gliders, are becoming popular companion pets and, consequently, the risk of potential infections that can be transmitted to humans should be investigated. Data on the role of the sugar glider as a possible carrier of pathogenic and zoonotic bacteria are scarce and fragmentary. Therefore, this study is aimed at evaluating the prevalence of potentially zoonotic bacteria (Salmonella spp., Escherichia coli, Campylobacter spp., Pseudomonas spp., Klebsiella spp., Listeria monocytogenes and Yersinia enterocolitica) in 64 sugar gliders kept as pets in Italy. The highest prevalence of infection pertained to members of the family Enterobacteriaceae, in particular Citrobacter spp. (50%), Enterobacter spp. (28·1%) and Klebsiella pneumoniae (15·6%); Pseudomonas aeruginosa was isolated from 10 out of 64 samples (15·6%). All strains of Klebsiella pneumoniae exhibited some level of resistance to multiple antimicrobials (ampicillin, amoxicillin-clavulanic acid and doxycycline). SIGNIFICANCE AND IMPACT OF THE STUDY: The results of this study show that sugar gliders may act as carriers of potentially pathogenic agents for humans and other animal species, therefore caution should be exercised in the handling and contact with these animals.
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Affiliation(s)
- L Varriale
- Department of Veterinary Medicine and Animal Productions, Università degli Studi di Napoli Federico II, Napoli, Italy
| | - T P Russo
- Department of Veterinary Medicine and Animal Productions, Università degli Studi di Napoli Federico II, Napoli, Italy
| | - A Pace
- Department of Veterinary Medicine and Animal Productions, Università degli Studi di Napoli Federico II, Napoli, Italy
| | - S Mediatore
- Department of Veterinary Medicine and Animal Productions, Università degli Studi di Napoli Federico II, Napoli, Italy
| | - L Borrelli
- Department of Veterinary Medicine and Animal Productions, Università degli Studi di Napoli Federico II, Napoli, Italy
| | - A Santaniello
- Department of Veterinary Medicine and Animal Productions, Università degli Studi di Napoli Federico II, Napoli, Italy
| | - L F Menna
- Department of Veterinary Medicine and Animal Productions, Università degli Studi di Napoli Federico II, Napoli, Italy
| | - A Fioretti
- Department of Veterinary Medicine and Animal Productions, Università degli Studi di Napoli Federico II, Napoli, Italy
| | - L Dipineto
- Department of Veterinary Medicine and Animal Productions, Università degli Studi di Napoli Federico II, Napoli, Italy
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Yumoto T, Kono Y, Kawano S, Kamoi C, Iida A, Nose M, Sato K, Ugawa T, Okada H, Ujike Y, Nakao A. Citrobacter braakii bacteremia-induced septic shock after colonoscopy preparation with polyethylene glycol in a critically ill patient: a case report. Ann Clin Microbiol Antimicrob 2017; 16:22. [PMID: 28376885 PMCID: PMC5379765 DOI: 10.1186/s12941-017-0201-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2017] [Accepted: 03/29/2017] [Indexed: 01/23/2023] Open
Abstract
Background Polyethylene glycol (PEG) is widely used for bowel cleaning in preparation for colonoscopy because of its safety. Septic shock after PEG preparation is an extremely rare complication. Herein, we describe a case of septic shock that occurred immediately after colonoscopy preparation with PEG. Case presentation A 75-year-old Japanese male who had previously developed diabetes after total pancreatectomy received PEG in preparation for colonoscopy. He had been admitted to the emergency intensive care unit 4 days earlier due to hematochezia presenting with shock. He ingested PEG to prepare for a colonoscopy examination, which was performed to identify the source of his bleeding over a 5-h period, but suddenly exhibited septic shock and markedly elevated procalcitonin levels. A blood culture subsequently revealed Citrobacter braakii. Immediate resuscitation and intensive care with appropriate antibiotics improved his condition. Conclusions Clinicians should be aware of the possibility of deteriorating conditions after bowel preparation with PEG among severely ill patients with recent episodes of hemorrhagic shock.
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Affiliation(s)
- Tetsuya Yumoto
- Advanced Emergency and Critical Care Medical Center, Okayama University Hospital, 2-5-1 Kita-ku, Shikata-cho, Okayama-shi, Okayama, 700-8558, Japan.
| | - Yoshiyasu Kono
- Department of Gastroenterology and Hepatology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, 2-5-1 Shikata-cho, Kita-ku, Okayama-shi, Okayama, 700-8558, Japan
| | - Seiji Kawano
- Department of Gastroenterology and Hepatology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, 2-5-1 Shikata-cho, Kita-ku, Okayama-shi, Okayama, 700-8558, Japan
| | - Chihiro Kamoi
- Advanced Emergency and Critical Care Medical Center, Okayama University Hospital, 2-5-1 Kita-ku, Shikata-cho, Okayama-shi, Okayama, 700-8558, Japan
| | - Atsuyoshi Iida
- Advanced Emergency and Critical Care Medical Center, Okayama University Hospital, 2-5-1 Kita-ku, Shikata-cho, Okayama-shi, Okayama, 700-8558, Japan
| | - Motoko Nose
- Department of Clinical Laboratory, Okayama University Hospital, 2-5-1 Shikata-cho, Kita-ku, Okayama-shi, Okayama, 700-8558, Japan
| | - Keiji Sato
- Advanced Emergency and Critical Care Medical Center, Okayama University Hospital, 2-5-1 Kita-ku, Shikata-cho, Okayama-shi, Okayama, 700-8558, Japan
| | - Toyomu Ugawa
- Advanced Emergency and Critical Care Medical Center, Okayama University Hospital, 2-5-1 Kita-ku, Shikata-cho, Okayama-shi, Okayama, 700-8558, Japan
| | - Hiroyuki Okada
- Department of Gastroenterology and Hepatology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, 2-5-1 Shikata-cho, Kita-ku, Okayama-shi, Okayama, 700-8558, Japan
| | - Yoshihito Ujike
- Department of Acute Care and Primary Care Medicine, Kawasaki Medical School Hospital, 577 Matsushima, Kurashiki-shi, Okayama, 701-0192, Japan
| | - Atsunori Nakao
- Advanced Emergency and Critical Care Medical Center, Okayama University Hospital, 2-5-1 Kita-ku, Shikata-cho, Okayama-shi, Okayama, 700-8558, Japan
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Hirai J, Uechi K, Hagihara M, Sakanashi D, Kinjo T, Haranaga S, Fujita J. Bacteremia due to Citrobacter braakii: A case report and literature review. J Infect Chemother 2016; 22:819-821. [PMID: 27553069 DOI: 10.1016/j.jiac.2016.07.003] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2016] [Revised: 07/05/2016] [Accepted: 07/07/2016] [Indexed: 11/16/2022]
Abstract
Among the Citrobacter genus, the most commonly isolated bacteria from human specimens are Citrobacter freundii and Citrobacter koseri, and previous cases of infection due to Citrobacter braakii have been rarely reported. We present a case of bacteremia due to C. braakii in a 38-year-old woman with cervical cancer. She was admitted to our hospital with complaints of a fever, chills, and nausea. Blood culture results showed gram-negative bacilli identified as C. braakii via matrix-assisted laser desorption/ionization time-of-flight mass spectrometry analysis, although biochemical testing findings were suggestive of C. freundii. Since a rare pathogen was detected in the present case and the results of additional biochemical studies were suggestive of both C. braakii and Citrobacter farmeri, genetic analysis was conducted. Finally, the gram-negative bacilli were confirmed as C. braakii, a member of the C. freundii complex since 1993, by 16S ribosomal RNA gene sequencing analysis. The gastrointestinal tract was considered the portal of entry, because the patient had a rectal fistula and other cultures such as urine and vaginal discharge incubated species other than C. braakii. The patient recovered after receiving treatment with ciprofloxacin for 14 days. The epidemiology and clinical characteristics of C. braakii infection are still unknown because of the limitations in accurate identification by using currently available commercial biochemical testing and previously, only 6 cases of C. braakii infection have been reported. Physicians should focus on this species, because it causes community-acquired infections, although further studies are needed to clarify the clinical characteristics of C. braakii infections.
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Affiliation(s)
- Jun Hirai
- Department of Infectious Diseases, Respiratory, and Digestive Medicine, Control and Prevention of Infectious Diseases, Faculty of Medicine, University of the Ryukyus, Japan
| | - Kohei Uechi
- Department of Infectious Diseases, Respiratory, and Digestive Medicine, Control and Prevention of Infectious Diseases, Faculty of Medicine, University of the Ryukyus, Japan
| | - Mao Hagihara
- Department of Infection Control and Prevention, Aichi Medical University Hospital, Japan
| | - Daisuke Sakanashi
- Department of Infection Control and Prevention, Aichi Medical University Hospital, Japan
| | - Takeshi Kinjo
- Department of Infectious Diseases, Respiratory, and Digestive Medicine, Control and Prevention of Infectious Diseases, Faculty of Medicine, University of the Ryukyus, Japan
| | - Shusaku Haranaga
- Department of Infectious Diseases, Respiratory, and Digestive Medicine, Control and Prevention of Infectious Diseases, Faculty of Medicine, University of the Ryukyus, Japan.
| | - Jiro Fujita
- Department of Infectious Diseases, Respiratory, and Digestive Medicine, Control and Prevention of Infectious Diseases, Faculty of Medicine, University of the Ryukyus, Japan
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Kim HS, Kim YJ, Chon JW, Kim DH, Kim KY, Seo KH. Citrobacter braakii
: A Major Cause of False-Positive Results on MacConkey and Levine's Eosin Methylene Blue Selective Agars Used for the Isolation of Escherichia Coli
from Fresh Vegetable Samples. J Food Saf 2015. [DOI: 10.1111/jfs.12210] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Hong-Seok Kim
- KU Center for Food Safety; College of Veterinary Medicine; Konkuk University; 120 Neungdong-ro, Gwangjin-gu Seoul 143-701 South Korea
| | - Young-Ji Kim
- KU Center for Food Safety; College of Veterinary Medicine; Konkuk University; 120 Neungdong-ro, Gwangjin-gu Seoul 143-701 South Korea
| | - Jung-Whan Chon
- KU Center for Food Safety; College of Veterinary Medicine; Konkuk University; 120 Neungdong-ro, Gwangjin-gu Seoul 143-701 South Korea
| | - Dong-Hyeon Kim
- KU Center for Food Safety; College of Veterinary Medicine; Konkuk University; 120 Neungdong-ro, Gwangjin-gu Seoul 143-701 South Korea
| | - Kwang-Yeop Kim
- KU Center for Food Safety; College of Veterinary Medicine; Konkuk University; 120 Neungdong-ro, Gwangjin-gu Seoul 143-701 South Korea
| | - Kun-Ho Seo
- KU Center for Food Safety; College of Veterinary Medicine; Konkuk University; 120 Neungdong-ro, Gwangjin-gu Seoul 143-701 South Korea
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Chen KJ, Chen TH, Sue YM. Citrobacter youngae and Pantoea agglomerans peritonitis in a peritoneal dialysis patient. Perit Dial Int 2014; 33:336-7. [PMID: 23660614 DOI: 10.3747/pdi.2012.00151] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Gursu M, Aydin Z, Pehlivanoglu F, Ozturk S, Karadag S, Uzun S, Tatli E, Kazancioglu R. Citrobacter peritonitis: two cases and review of the literature. Perit Dial Int 2011; 31:409-11. [PMID: 21799055 DOI: 10.3747/pdi.2010.00114] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
One of the uncommon gram negative organisms causing peritonitis in peritoneal dialysis patients is Citrobacter. Because of this organism's resistant nature, treatment for Citrobacter peritonitis may be difficult, and removal of the catheter may be necessary in refractory cases. Here we present 2 cases of peritonitis caused by this organism and fully treated with antibiotics. The literature contains only a limited number of reports on Citrobacter peritonitis, mostly case reports or portions of general papers about the microbiological spectrum of peritonitis in the relevant units. Until enough data about this micro-organism have been accumulated to map out an approach, it is wise to individualize treatment by watching the response of the patient during the wait for the antibiogram result and not to hesitate to remove the catheter if the clinical situation deteriorates.
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Affiliation(s)
- Meltem Gursu
- Nephrology, Haseki Training and Research Hospital, Bezmialem Vakif University Faculty of Medicine, Istanbul, Turkey.
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Lai CC, Tan CK, Lin SH, Liu WL, Liao CH, Huang YT, Hsueh PR. Bacteraemia caused by non-freundii, non-koseri Citrobacter species in Taiwan. J Hosp Infect 2010; 76:332-5. [PMID: 20708303 DOI: 10.1016/j.jhin.2010.06.006] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2010] [Accepted: 06/01/2010] [Indexed: 11/18/2022]
Abstract
This study analysed the clinical characteristics of bacteraemia due to unusual Citrobacter species. All non-freundii and non-koseri Citrobacter isolates were identified to species level by two commercial identification methods and 16S rRNA gene sequence analysis. A total of 306 patients with Citrobacter spp. bacteraemia were identified from January 2000 through December 2009. Four patients (1.3%) had C. braakii bacteraemia, and one had C. amalonaticus and C. sedlakii sepsis, respectively. Misidentification as non-freundii and non-koseri Citrobacter spp., which occurred in eight isolates with the Phoenix automated system PMIC/ID-30 and three with the Vitek II system, occurred in five of six infection episodes. Among the six patients with bacteraemia caused by non-freundii and non-koseri Citrobacter spp., five (83.3%) had healthcare-associated infection and five (83.3%) infections were secondary to intra-abdominal infection. Cancer and liver cirrhosis were the commonest underlying diseases. An attributable mortality was 33.3%. Antimicrobial susceptibility testing showed that the resistance patterns varied among different Citrobacter species. Non-freundii and non-koseri Citrobacter species are difficult to identify and are a rare cause of intra-abdominal infections with secondary healthcare-associated bacteraemia in immunocompromised patients.
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Affiliation(s)
- C-C Lai
- Department of Intensive Care Medicine, Chi Mei Medical Center, Liouying, Tainan, Taiwan
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Lee HM, Bae SH, Lee SN, Lee JW, Shin AY, Yu SY, Lee SY, Youn MH, Han SY, Han NI, Lee YS, Yoo JH. A Case of Citrobacter braakiiSepsis Complicated with Hepatocellular Carcinoma. Infect Chemother 2010. [DOI: 10.3947/ic.2010.42.3.190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Affiliation(s)
- Hae Mi Lee
- Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Sung Ha Bae
- Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Su Nam Lee
- Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Jung Woo Lee
- Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Ah Young Shin
- Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Si Young Yu
- Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Soo-Yeon Lee
- Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Moon Hee Youn
- Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Sun-Young Han
- Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Nam Ik Han
- Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Young Sok Lee
- Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Jin-Hong Yoo
- Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea
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Nicolosi D, Nicolosi VM, Cappellani A, Nicoletti G, Blandino G. Antibiotic susceptibility profiles of uncommon bacterial species causing severe infections in Italy. J Chemother 2009; 21:253-60. [PMID: 19567344 DOI: 10.1179/joc.2009.21.3.253] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
This study presents the results of the italian "Severe infections project" involving bacteria that can be considered rare causes of disease. we isolated 30 uncommon human pathogens from a total of 60 strains (1.2% of all the isolates). The most frequent sources of uncommon human pathogens were primary bloodstream infections (48.3%) and pneumonia (20%). Species such as Comamonas testosteroni, Enterococcus hirae, Kluyvera ascorbata, Kluyvera cryocrescens, Leclercia adecarboxylata and Ochrobactrum anthropi were recovered from bacteremia patients. Clinically useful antimicrobial agents were tested against each isolate. Resistance to 4 or more antibiotics tested was found in Achromobacter xylosoxidans, O. anthropi, Pseudomonas stutzeri, Citrobacter braakii, Enterobacter sakazakii, K. ascorbata, Proteus penneri and Serratia plymuthica. About 16% of the Gram-negative species were resistant to third-generation cephalosporins and 28.6% of the staphylococci were oxacillin-resistant. the results from this study offer indications for empirical therapy for severe infections from uncommon human pathogens.
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Affiliation(s)
- D Nicolosi
- Department of Microbiological Sciences, University of Catania, Italy
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