Urology Annals
About UA | Search | Ahead of print | Current Issue | Archives | Instructions | Online submissionLogin 
Urology Annals
  Editorial Board | Subscribe | Advertise | Contact
Users Online: 159   Home Print this page  Email this page Small font size Default font size Increase font size


 
Table of Contents
COMMENTARY
Year : 2013  |  Volume : 5  |  Issue : 4  |  Page : 313-314  

Citrobacter: An emerging health care associated urinary pathogen


Department of Microbiology, G. R. Medical College, Gwalior, Madhya Pradesh, India

Date of Web Publication24-Oct-2013

Correspondence Address:
K P Ranjan
Department of Microbiology, G. R. Medical College, Gwalior, Madhya Pradesh
India
Login to access the Email id


PMID: 24311922

Rights and Permissions

How to cite this article:
Ranjan K P, Ranjan N. Citrobacter: An emerging health care associated urinary pathogen. Urol Ann 2013;5:313-4

How to cite this URL:
Ranjan K P, Ranjan N. Citrobacter: An emerging health care associated urinary pathogen. Urol Ann [serial online] 2013 [cited 2020 Aug 6];5:313-4. Available from: http://www.urologyannals.com/text.asp?2013/5/4/313/120297

Hospital-acquired urinary tract infection (UTI) is the commonest health care associated infection (nosocomial infection) accounting for 35-40% of the total health care infections, thus posing a serious health threat. [1] Also, the prevalence of antimicrobial resistance among urinary pathogens has increased worldwide due to uncontrolled and indiscriminate antibiotic usage. [2] Adding to it, certain pathogens which were isolated sporadically have now emerged as prominent health care associated pathogens.

The author reports the emergence of Citrobacter as a common urinary pathogen in hospitalized patients. The genus Citrobacter was discovered in 1932 by Werkman and Gillen. These organisms are found in soil, water, intestinal tract of animals, and in human clinical samples. Members of the genus Citrobacter are gram-negative, non-sporing rods belonging to family Enterobacteriaceae and, as the name suggests, usually utilize citrate as a sole carbon source. The genus now consists of 11 genomospecies separable by their biochemical characteristics. Out of them, C. koseri has been associated with cases of neonatal meningitis and brain abscess and C. freundii with gastroenteritis, neonatal meningitis, and septicemia. [3] It is known to cause health care associated infections of the urinary tract, respiratory tract, blood, and other normally sterile sites in the body. The chief cause is a weak and attenuated immune system and functioning of the body. A frail immune system makes the body more vulnerable and predisposed to C. freundii, thus triggering UTI or intestinal infection or meningitis. Hospitalized patients, especially those who have been hospitalized for a prolonged period of time, are more vulnerable to C. freundii infections.

The authors have conducted a retrospective study and have reported Citrobacter spp. as the third most common urinary pathogen accounting for 9.4% of the total isolates. The isolation of this organism was associated with catheterization, genitourinary instrumentation, or obstructive uropathy. Also, the age group most affected was that of elderly hospitalized patients, especially males. Their finding emphasizes the role of this organism as a common health care associated pathogen. Recently, a study conducted in Nepal also reported Citrobacter spp. as the second most common urinary pathogen in their study. [4]

Although Citrobacter spp. are less commonly isolated, they are emerging as a common nosocomial multidrug-resistant pathogen, especially in developing countries. UTI caused by Citrobacter spp. have been seen in 12% patients in 1961, and since then, its prevalence has been increasing. [5] Invasive procedures like catheterization or genitourinary instrumentation seem to assist the organism in colonization and infection of urinary tract. Another matter of concern is the emergence of multidrug-resistant Citrobacter spp., resulting in reduced therapeutic options which further complicate the situation. The author also reported that most of the isolates were resistant to penicillins, cephalosporins, aminoglycosides, and fluoroquinolones, which are the commonly prescribed drugs in UTI. Resistance to many groups of antibiotics has been observed and many mechanisms of drug resistance have been demonstrated in Citrobacter spp. In a study concluded by Shobha et al., Citrobacter spp. was the third most common urinary pathogen and 30% of the isolates were extended spectrum beta lactamase (ESBL) producers. [6] Meher Rizvi et al. reported that 62.2% of Citrobacter isolates were producing ESBL. [7] High level carbapenem resistance was also reported in C. freundii due to combination of Klebsiella pneumoniae Scientific Name Search  carbapenemase-2 (KPC-2) production and decreased porin expression. [8] Carbapenems are important antibiotics for the treatment of health care associated infections and have a special role in treating infection with ESBL-producing organisms. The emergence and spread of resistance to carbapenems will end all the treatment options available for treating multidrug-resistant pathogens.

In conclusion, the emergence of this usually rare organism as a common nosocomial urinary pathogen is alarming. As the drug options are limited in the current scenario, injudicious and inadequate use of antibiotics should be avoided, at least till scientists worldwide find some new revolutionary drug which can counter all these drug resistance mechanisms. Till then, studies like this should be carried out in different institutes as the prevalence and antibiotic susceptibility patterns vary enormously even in different institutes of the same geographic area. Infection control practices should be observed strictly and any type of unnecessary instrumentation should be avoided.

 
   References Top

1.Kalsi J, Arya M, Wilson P, Mundy A. Hospital-acquired urinary tract infection. Int J Clin Pract 2003;57:388-91.  Back to cited text no. 1
    
2.Bonadio M, Meini M, Spetaleri P, Gilgi C. Current microbiological and clinical aspects of urinary tract infections. Eur Urol 2001;40:439-45.  Back to cited text no. 2
    
3.Murray PR, Holmes B, Aucken HM. Citrobacter, Enterobacter, Klebsiella, Plesiomonas, Serratia, and other members of the enterobacteriaceae. Topley and Wilson's microbiology and microbial infections. 2010, Edward Arnold, London.  Back to cited text no. 3
    
4.Baral P, Neupane S, Marasini BP, Ghimire KR, Lekhak B, Shrestha B. High prevalence of multidrug resistance in bacterial uropathogens from Kathmandu, Nepal. BMC Res Notes 2012;5:38.  Back to cited text no. 4
    
5.Whitby JL, Muir GG. Bacteriological studies of urinary tract infection. Br J Urol 1961;33:130-4.  Back to cited text no. 5
    
6.Shobha KL, Gowrish Rao S, Rao S, Sreeja CK. Prevalence of extended spectrum Beta-Lactamases in urinary isolates of Escherichia coli, Klebsiella and Citrobacter species and their antimicrobial susceptibility pattern in a tertiary care hospital. Indian J Practising Doctor 3:2007-01- 2007-02.  Back to cited text no. 6
    
7.Rizvi M, Fatima N, Shukla I, Malik A. Epidemiology of extended spectrum β-lactamases in Serratia and Citrobacter species in North India. Indian J Pathol Microbiol 2010;53:193-4.  Back to cited text no. 7
[PUBMED]  Medknow Journal  
8.Zhang R, Yang L, Cai JC, Zhou HW, Chen GX. High-level carbapenem resistance in a Citrobacter freundii clinical isolate is due to a combination of KPC-2 production and decreased porin expression. J Med Microbiol 2008;57:332-7.  Back to cited text no. 8
    




 

Top
 
  Search
 
    Similar in PUBMED
   Search Pubmed for
   Search in Google Scholar for
    Access Statistics
    Email Alert *
    Add to My List *
* Registration required (free)  

 
  In this article
    References

 Article Access Statistics
    Viewed1698    
    Printed41    
    Emailed1    
    PDF Downloaded367    
    Comments [Add]    

Recommend this journal