Antibiotic resistance in Citrobacter spp. isolated from urinary tract infection

Metri, Basavaraj C; Jyothi, P; Peerapur, B V

doi:10.4103/0974-7796.120295

Cited by 40 publications

(15 citation statements)

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“…It was particularly unexpected that C. freundii was isolated from almost a quarter (23.6 %) of the collected urine samples, accounting for 38.6 % of all non- E.coli isolates. While surprising, our findings are in agreement with a number of recent studies that have reported on the increased incidence of Citrobacter among urinary pathogens in developing countries [ 30 – 32 ], thus suggesting that Citrobacter may be becoming an increasingly important emerging urinary tract pathogen in resource-limited settings [ 33 ]. The high percentage of the non- E. coli UTI-associated bacteria analyzed in this study may also indicate weakened immune systems or additional health problems in the studied population.…”

Section: Discussionsupporting

confidence: 92%

High prevalence of multidrug resistant Enterobacteriaceae isolated from outpatient urine samples but not the hospital environment in Bo, Sierra Leone

et al. 2016

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BackgroundThe rising level of antimicrobial resistance among bacterial pathogens is one of the most significant public health problems globally. While the antibiotic resistance of clinically important bacteria is closely tracked in many developed countries, the types and levels of resistance and multidrug resistance (MDR) among pathogens currently circulating in most countries of sub-Saharan Africa are virtually unknown.MethodsFrom December 2013 to April 2014, we collected 93 urine specimens from all outpatients showing symptoms of urinary tract infection (UTI) and 189 fomite swabs from a small hospital in Bo, Sierra Leone. Culture on chromogenic agar combined with biochemical and DNA sequence-based assays was used to detect and identify the bacterial isolates. Their antimicrobial susceptibilities were determined using a panel of 11 antibiotics or antibiotic combinations.ResultsThe 70 Enterobacteriaceae urine isolates were identified as Citrobacter freundii (n = 22), Klebsiella pneumoniae (n = 15), Enterobacter cloacae (n = 15), Escherichia coli (n = 13), Enterobacter sp./Leclercia sp. (n = 4) and Escherichia hermannii (n = 1). Antimicrobial susceptibility testing demonstrated that 85.7 % of these isolates were MDR while 64.3 % produced an extended-spectrum ß-lactamase (ESBL). The most notable observations included widespread resistance to sulphonamides (91.4 %), chloramphenicol (72.9 %), gentamycin (72.9 %), ampicillin with sulbactam (51.4 %) and ciprofloxacin (47.1 %) with C. freundii exhibiting the highest and E. coli the lowest prevalence of multidrug resistance. The environmental cultures resulted in only five Enterobacteriaceae isolates out of 189 collected with lower overall antibiotic resistance.ConclusionsThe surprisingly high proportion of C. freundii found in urine of patients with suspected UTI supports earlier findings of the growing role of this pathogen in UTIs in low-resource countries. The isolates of all analyzed species showed worryingly high levels of resistance to both first- and second-line antibiotics as well as a high frequency of MDR and ESBL phenotypes, which likely resulted from the lack of consistent antibiotic stewardship policies in Sierra Leone. Analysis of hospital environmental isolates however suggested that fomites in this naturally ventilated hospital were not a major reservoir for Enterobacteriaceae or antibiotic resistance determinants.Electronic supplementary materialThe online version of this article (doi:10.1186/s12879-016-1495-1) contains supplementary material, which is available to authorized users.

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Section: Discussionsupporting

confidence: 92%

High prevalence of multidrug resistant Enterobacteriaceae isolated from outpatient urine samples but not the hospital environment in Bo, Sierra Leone

et al. 2016

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“…Among these some colonies were identified as Klebsiella oxytoca/Raoultella ornithinolytica/Citrobacter freundii , all potentially pathogenic microorganisms. For instance, Klebsiella and Citrobacter have been associated to urinary tract infection [ 31 , 32 ], while Roultella ornithinolytica is associated to aqueous environment, soil, trees and insects and it has been recognized as implicated in cases of human infection [ 33 ]. Also the species Serratia marcescens was detected in bee pollen samples, and the presence of this opportunistic pathogen has been previously demonstrated by Brindza et al .…”

Section: Resultsmentioning

confidence: 99%

Microbial characterization of bee pollen from the Vesuvius area collected by using three different traps

Mauriello

Prisco

et al. 2017

PLoS ONE

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Flower pollen is collected by honeybee foragers, adhered on their rear legs and transported into the hives in the form of pellets. Once in the hives, bee pollen is moisturised with nectar and bee mouth secretions and due to enzymatically modifications it becomes the so-called bee-bread, the protein reservoir of young bees. Bee pollen can be artificially removed from bee legs and collected by using specific systems, the bee pollen traps. Bee pollen is commercialized for human consumption as fresh product and after freezing or drying. Although bee pollen is nowadays largely consumed in developed countries, as food or food supplement according to local legislation, little is known on its safety related to microbiological hazards. In this work, we aimed to characterize for the first time the microbiological profile of Italian bee pollen in fresh, frozen and dried form collected along an entire harvesting season. Moreover, monthly microbiological analyses were performed on frozen (storage at -18°C) and dried (storage at room temperature) bee pollen over a 4 months period. Further aim of this work was the evaluation of the possible impact on production level of three different traps used for pollen collection. Our results on microbial contamination of fresh and frozen bee pollen show that a more comprehensive microbiological risk assessment of bee pollen is required. On the other side, dried pollen showed very low microbial contamination and no pathogen survived after the drying process and during storage.

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“…Discussion of these three genera together is justified by their similar biochemical characteristics, prevalence, and resistance trends [8]. The pathogenic role of CES bacteria has been described in urinary tract infections, respiratory tract infections, bacteremia and sepsis, gastroenteritis, conjunctivitis, wound infections, endocarditis, meningitis (both in adults and neonates), and brain abscesses [2,9,10,11,12,13,14,15,16,17,18,19,20,21]. In recent years, outbreaks associated with CES bacteria has become more frequent (especially in neonatal and adult intensive care units), highlighting that these bacteria pose a serious concern from an infection control perspective [9,10,11,12,13,14,15,16,17,18,19,20,21].…”

Section: Introductionmentioning

confidence: 99%

“…Compared to E. coli , members of CES are more frequently isolated in complicated UTIs (associated with catheters, functional or anatomical abnormalities of the genitourinary tract) from patients with underlying conditions or immunosuppression. They are also more frequently associated with pyelonephritis, recurrence, and prolonged therapy [9,10,12,13,14,15,18,20,21]. CES bacteria present a challenge to clinicians and microbiologists alike due to the various intrinsic and acquired resistance mechanisms they possess.…”

Section: Introductionmentioning

confidence: 99%

Resistance Trends and Epidemiology of Citrobacter-Enterobacter-Serratia in Urinary Tract Infections of Inpatients and Outpatients (RECESUTI): A 10-Year Survey

Gajdács

Urbán

2019

Medicina

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Background and objectives: Urinary tract infections (UTIs) are the third most common infections in humans, representing a significant factor of morbidity, both among outpatients and inpatients. The pathogenic role of Citrobacter, Enterobacter, and Serratia species (CES bacteria) has been described in UTIs. CES bacteria present a therapeutic challenge due to the various intrinsic and acquired resistance mechanisms they possess. Materials and Methods: The aim of this study was to assess and compare the resistance trends and epidemiology of CES pathogens in UTIs (RECESUTI) in inpatients and outpatients during a 10-year study period. To evaluate the resistance trends of isolated strains, several antibiotics were chosen as indicator drugs based on local utilization data. 578 CES isolates were obtained from inpatients and 554 from outpatients, representing 2.57 ± 0.41% of all positive urine samples for outpatients and 3.02 ± 0.40% for inpatients. E. cloacae was the most prevalent species. Results: The ratio of resistant strains to most of the indicator drugs was higher in the inpatient group and lower in the second half of the study period. ESBL-producing isolates were detected in 0–9.75% from outpatient and 0–29.09% from inpatient samples. Conclusions: Resistance developments of CES bacteria, coupled with their intrinsic non-susceptibility to several antibiotics, severely limits the number of therapeutic alternatives, especially for outpatients.

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Antibiotic resistance in Citrobacter spp. isolated from urinary tract infection

Cited by 40 publications

References 6 publications

High prevalence of multidrug resistant Enterobacteriaceae isolated from outpatient urine samples but not the hospital environment in Bo, Sierra Leone

High prevalence of multidrug resistant Enterobacteriaceae isolated from outpatient urine samples but not the hospital environment in Bo, Sierra Leone

Microbial characterization of bee pollen from the Vesuvius area collected by using three different traps

Resistance Trends and Epidemiology of Citrobacter-Enterobacter-Serratia in Urinary Tract Infections of Inpatients and Outpatients (RECESUTI): A 10-Year Survey

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