Resistance to Extended-Spectrum Cephalosporins and Mortality in Patients with Citrobacter freundii Bacteremia

Abstract

Background:This study was performed to characterize the clinical features and to identify the risk factors for resistance to extended-spectrum cephalosporins (ESCs) and for mortality in patients with Citrobacter freundii bacteremia. Patients and Methods: 105 patients (aged ≥ 15 years) with C. freundii bacteremia in 1991-2000 were retrospectively analyzed. Results: Nosocomial acquisition was identified in 78.1% of the patients. Hepatic, biliary and pancreatic disease was the most common underlying disease (65.7%) and the biliary tract was the most common site of infection (50.5%). The overall resistance rate to ESCs was 59.0% and was significantly associated with hepatic, biliary and pancreatic disease, recent surgery and procedure, biliary drainage catheter and previous antibiotic therapy in univariate analysis. However, only previous antibiotic therapy with ESCs (OR = 5.0, 95% CI 1.6-15.7, p = 0.006) and recent surgery or procedure (OR = 3.1, 95% CI 1.1-8.4, p = 0.03) were strong, independent risk factors in multivariate analysis. Mortality directly related to C. freundii bacteremia was 21.9% and there was no difference between cases with resistance and susceptibility to ESCs (19.4% vs 25.6%; p = 0.45). Mortality was significantly associated with rapidly fatal or ultimately fatal underlying disease, a solid tumor, septic shock and polymicrobial bacteremia in univariate analysis. Among patients who had therapeutic surgical procedures, mortality was lower (4.5%, p = 0.04). Multivariate analysis revealed rapidly or ultimately fatal disease, septic shock and polymicrobial bacteremia as independent prognostic factors.

Predictors of In‐Hospital Mortality for Bloodstream Infections Caused by Enterobacter Species or Citrobacter freundii

“…26,29 Of note, one previous description of C. freundii bacteremias (105 isolates) did not find the same association of mortality with extended-spectrum cephalosporin resistance. 30 The effects of antimicrobial therapy against Enterobacter sp and C. freundii were also examined in small, single-center studies, and no differences were found in rates of clinical cure or mortality based on appropriateness of therapy or treatment strategy. 7,26 This is an interesting finding in light of other studies that detail the impact of appropriate antimicrobial therapies on clinical outcomes in other nosocomial infections in critically ill patients.…”

Outcome of bloodstream infections among spinal cord injury patients and impact of multidrug-resistant organisms

“…At last, Chang et al 25 during Enterobacter aerogenes bacteremia found that resistance to extended-spectrum cephalosporins was an independent risk factor for mortality (OR = 9.21; 95% CI: 1.02-83.04; P = 0.048). However, other reports state that MDROs could have no impact on mortality, as suggested by Kim et al 26 They found no difference in BSI caused by resistant or susceptible to extended-spectrum cephalosporins Citrobacter freundii (19.4% vs 25.6%; P = 0.45).…”

Enhancement of Lactic Acid Bacteria by Gamma Radiation to Inhibit Antibiotic Resistance of some Salmonella spp.

“…Citrobacter freundii is also known to contain in its chromosome a gene coding for cephalosporinase. This enzyme hydrolyses the −CO−NH− bond in the lactam ring of cephalosporins and cephamycis thus, rendering the bacteria resistant to this type of antibiotics [15,16] didn't find a single antibiotic to be effective bactericidal agent against uropathogenic P. mirabilis strains collected from patients in Polish. Gamma radiation was used as a tool to increase the antimicrobial activity of L. acidophilus and S. thermophilus towards the three pathogens.…”