Journal of Medical and Scientific Research (Oct 2019)
Prevalence and antimicrobial susceptibility pattern of Citrobacter species in various clinical samples in a tertiary care hospital
Abstract
Background: Infections with Citrobacter species have been increasing across worldwide. Earlier, considered to be organism of low virulence but now known to cause variety of infections with high mortality as high approximately one-third of infants with abscesses die, and one-half sustain central nervous system (CNS) damage. Objective: The present study aims to determine the prevalence and antibiotic susceptibility pattern of Citrobacter species from various clinical samples in a tertiary care hospital. Material and methods: This one year prospective observational study, conducted in the Department of Microbiology at Krishna Institute of Medical Sciences, Secunderabad from January 2018 to December 2018. The samples received to the laboratory from both outpatient and inpatient from various departments. Identification and antimicrobial susceptibility of the isolates were done by using Vitek 2 compact automated system (bioMerieux). Results: In 3,337 culture positive sample, 83 (2.4%) isolates were found to be culture positive for Citrobacter species where C. koseri (n=57) is predominant followed by C. freundii (n=24) and C. amalonaticus (n=2). Majority of Citrobacter species were isolated from urine samples 56% followed by pus 21%, sputum 8.43%, blood 7.2% and in bile fluid 3.6%. The highest incidence was found in elderly patients of age group 51-80 year age group, more common in males (70%) than females (30%). The susceptibility pattern for C. koseri is 100% in tigecycline and colistin each respectively. Piperacillin-tazobactum (84%), cefoperazone-sulbactum (94%), amikacin (96%), gentamycin (98%), ertapenem (91.2%), imipenem (92%), meropenem (89%), ceftriaxone (75.4%), cefepime (92%), ciprofloxacin (87%), nitrofurantoin (89.4%), nalidixic acid (80.7%) and trimethoprim-sulfamethoxazole (96.4%). The susceptibility pattern observed in C. freundii is piperacillin-tazobactum (75%), cefoperazone-sulbactum (83.3%), amikacin 79%, gentamycin 70.8% showed 79 %, ertapenem (87.5%), imipenem (91.6%), meropenem (87.5%), ceftriaxone (62.5%), cefepime (87.5%), ciprofloxacin (75%), nitrofurantoin (79%), nalidixic acid (62.5%) and trimethoprim-sulfamethoxazole (75%). Tigecycline and colistin showed excellent susceptibility of 100%. Conclusion: The present study highlight that Citrobacter species are an emerging pathogen with prevalence of 2.4%. It is the most common uropathogen followed by pus and sputum, and bacteraemia also. C. freundii was comparatively less susceptible as compared to C. koseri. Antibiotic policy should be implemented strictly and followed strongly so that emergence of such low virulent organism with emerging resistance can be controlled.
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