title: Emergence of cefotaxime resistance in Citrobacter freundii causing necrotizing fasciitis and osteomyelitis.
abstract: We present a diabetic patient with necrotizing fasciitis caused by Citrobacter freundii associated with an injury from the fish fin. Two isolates recovered six days after cefotaxime treatment had a cefotaxime minimum inhibitory concentration (MIC) of 0.12 and 256 mg/L, respectively, and a cefepime MIC of 0.03 and 0.25 mg/L, respectively. The two isolates both possessed bla(CMY-2) gene. The patient responded unsatisfactorily to cefotaxime and cefepime therapy and surgical debridement but recovered completely after ertapenem treatment for 42 days.
authors.affiliation: Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan.
authors.forename: Yu-Min
authors.initials: YM
authors.lastname: Chuang
authors.forename: Sung-Pin
authors.initials: SP
authors.lastname: Tseng
authors.forename: Lee-Jene
authors.initials: LJ
authors.lastname: Teng
authors.forename: Ya-Chi
authors.initials: YC
authors.lastname: Ho
authors.forename: Po-Ren
authors.initials: PR
authors.lastname: Hsueh
mesh_terms: D000900:Anti-Bacterial Agents / Q000494:pharmacology; D000077723:Cefepime; D002439:Cefotaxime / Q000494:pharmacology*; D018550:Cephalosporin Resistance; D002511:Cephalosporins / Q000627:therapeutic use; D016971:Citrobacter freundii / Q000187:drug effects*; D004756:Enterobacteriaceae Infections / Q000188:drug therapy / Q000382:microbiology*; D000077727:Ertapenem; D019115:Fasciitis, Necrotizing / Q000188:drug therapy / Q000382:microbiology*; D005260:Female; D006801:Humans; D008875:Middle Aged; D010019:Osteomyelitis / Q000188:drug therapy / Q000382:microbiology*; D014947:Wounds and Injuries / Q000150:complications; D047090:beta-Lactams / Q000627:therapeutic use
chemical_list: D000900:Anti-Bacterial Agents; D002511:Cephalosporins; D047090:beta-Lactams; D000077723:Cefepime; D000077727:Ertapenem; D002439:Cefotaxime