title: Bacteraemia caused by non-freundii, non-koseri Citrobacter species in Taiwan.
abstract: This study analysed the clinical characteristics of bacteraemia due to unusual Citrobacter species. All non-freundii and non-koseri Citrobacter isolates were identified to species level by two commercial identification methods and 16S rRNA gene sequence analysis. A total of 306 patients with Citrobacter spp. bacteraemia were identified from January 2000 through December 2009. Four patients (1.3%) had C. braakii bacteraemia, and one had C. amalonaticus and C. sedlakii sepsis, respectively. Misidentification as non-freundii and non-koseri Citrobacter spp., which occurred in eight isolates with the Phoenix automated system PMIC/ID-30 and three with the Vitek II system, occurred in five of six infection episodes. Among the six patients with bacteraemia caused by non-freundii and non-koseri Citrobacter spp., five (83.3%) had healthcare-associated infection and five (83.3%) infections were secondary to intra-abdominal infection. Cancer and liver cirrhosis were the commonest underlying diseases. An attributable mortality was 33.3%. Antimicrobial susceptibility testing showed that the resistance patterns varied among different Citrobacter species. Non-freundii and non-koseri Citrobacter species are difficult to identify and are a rare cause of intra-abdominal infections with secondary healthcare-associated bacteraemia in immunocompromised patients.
authors: Department of Intensive Care Medicine, Chi Mei Medical Center, Liouying, Tainan, Taiwan.
authors: C-C
authors: CC
authors: Lai
authors: C-K
authors: CK
authors: Tan
authors: S-H
authors: SH
authors: Lin
authors: W-L
authors: WL
authors: Liu
authors: C-H
authors: CH
authors: Liao
authors: Y-T
authors: YT
authors: Huang
authors: P-R
authors: PR
authors: Hsueh
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000494:pharmacology; D016470:Bacteremia / Q000382:microbiology* / Q000401:mortality / Q000473:pathology*; D015373:Bacterial Typing Techniques; D002954:Citrobacter / Q000145:classification* / Q000302:isolation & purification*; D004269:DNA, Bacterial / Q000737:chemistry / Q000235:genetics; D004275:DNA, Ribosomal / Q000737:chemistry / Q000235:genetics; D004756:Enterobacteriaceae Infections / Q000382:microbiology* / Q000401:mortality / Q000473:pathology*; D005260:Female; D006801:Humans; D008297:Male; D008826:Microbial Sensitivity Tests; D012336:RNA, Ribosomal, 16S / Q000235:genetics; D017422:Sequence Analysis, DNA; D013624:Taiwan
chemical_list: D000900:Anti-Bacterial Agents; D004269:DNA, Bacterial; D004275:DNA, Ribosomal; D012336:RNA, Ribosomal, 16S