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Published in Jamie Bartram, Rachel Baum, Peter A. Coclanis, David M. Gute, David Kay, Stéphanie McFadyen, Katherine Pond, William Robertson, Michael J. Rouse, Routledge Handbook of Water and Health, 2015
Klebsiella spp. is a natural inhabitant of many water environments. In drinking water distributions, they are known to colonize water taps. Like other bacteria and non-ferment Gram-negative pathogens, they are generally biofilm organisms. In well-treated plumbing systems, Klebsiella spp. can be found. But in sink drains and sanitations systems Klebsiella spp. are often isolated in high concentrations. Especially in nosocomial outbreaks, water, water outlets, and sink drains must be regarded as infection reservoirs. The same is true for Enterobacter spp. and Citrobacter spp. In a recent outbreak in Germany a broad spectrum of antibiotic-resistant bacteria including Klebsiella spp., Enterobacter spp., E. coli, Citrobacter spp. and Raoultella were found as colonizing pathogens in more than 140 patients. All of the different Enterobacteriaceae had a KPC2-wearing plasmid. An infection reservoir in the sanitation system of the hospital with 525 beds was identified. After breaking the transmission pathway the outbreak could be brought under control.13
Combination Antimicrobial Therapy for Gram-Negative Infections: What Is the Evidence?
Published in Robert C. Owens, Lautenbach Ebbing, Antimicrobial Resistance, 2007
Citrobacter species are increasingly being recognized as an important, although still relatively infrequent cause of bacteremia in hospitalized patients (151). Citrobacter species have been implicated in various infections including surgical wound infections (152,153), cellulitis (154–156), urinary tract infections (153,157), and bacteremias (158). Most patients who develop these infections have underlying risk factors such as prolonged hospital stays, immunosuppression, malignancy, hepatobiliary disease, and invasive devices (159–161). Frequently associated with polymicrobial bacteremia, studies have found mortality associated with this pathogen ranging from 22% to 56% (158,160,162–164), probably a reflection of the critically ill state of the host.
Plazomicin
Published in M. Lindsay Grayson, Sara E. Cosgrove, Suzanne M. Crowe, M. Lindsay Grayson, William Hope, James S. McCarthy, John Mills, Johan W. Mouton, David L. Paterson, Kucers’ The Use of Antibiotics, 2017
Plazomicin has in vitro antibacterial activity against many antibiotic-susceptible and antibiotic-resistant Gram-negative pathogens. Clinically important enteric bacteria such as Citrobacter spp., Escherichia coli, Klebsiella spp., Enterobacter spp., and Serratia spp. are generally inhibited with MIC90 values in the range of 0.5–2 mg/l (Aggen et al., 2010; Almaghrabi et al., 2014; Endimiani et al., 2009; Galani et al., 2012; Landman et al., 2010; Landman et al., 2011; Livermore et al., 2011; Rodriguez-Avial et al., 2015; Walkty et al., 2014). Proteus spp. and Morganella spp. are less sensitive to plazomicin, with MIC90 values of 4 to 8 mg/l and 8–64 mg/l, respectively (Aggen et al., 2010; Kotlovsky et al., 2011; Castanheira et al., 2015). The range of plazomicin MICs against Salmonella and Shigella spp. is 0.5–8 mg/l, with an MIC90 of 8 mg/l, similar to the Proteae (Aggen et al., 2010). Activity against nonfermentative bacteria is generally less than against Enterobacteriaceae. Plazomicin MIC50 values can range from 2–16 mg/l against Pseudomonas aeruginosa and Acinetobacter spp., with plazomicin MIC90 values of 16–32 mg/l for recent collections of P. aeruginosa and 16 mg/l for Acinetobacter spp. from the USA and Europe (Aggen et al., 2010; Landman et al., 2011; Walkty et al., 2014; Castanheira et al., 2015; Garcia-Salguero et al., 2015). The compound is inactive against Stenotrophomonas maltophilia with MIC50/MIC90 values of 64/>64 mg/l (Walkty et al., 2014).
Ceftobiprole medocaril for the treatment of pneumonia
Published in Expert Review of Anti-infective Therapy, 2023
Wan-Hsuan Hsu, Chi-Kuei Hsu, Chih-Cheng Lai
Other than the bacteria mentioned above, the CANWARD surveillance study, which assessed the in vitro susceptibility of antimicrobials based on the breakpoints approved by Health Canada, delineated that 99.2% of 647 Proteus mirabilis clinical isolates, 97.9% of 261 Klebsiella aerogenes clinical isolates, 97.8% of 647 Serratia marcescens clinical isolates, 94.3% of Citrobacter freundii clinical isolates, 88.9% of 668 Klebsiella oxytoca clinical isolates, and 87.2% of 1064 Enterobacter cloacae clinical isolates were classified as susceptible to ceftobiprole [43]. Among the clinical isolates collected from the United States, ceftobiprole was comparable to other extended-spectrum cephalosporins (under CLSI criteria) in terms of activity against isolates of Enterobacter spp. (80.0% susceptible), Citrobacter spp. (82.2% susceptible), Proteus mirabilis (95.9% susceptible), and Serratia spp. (89.5% susceptible) [42]. Besides, ceftobiprole also revealed significant antimicrobial activity against Acinetobacter baumannii with the MIC50 value of ≤1 mg/L and the MIC90 value of 2 mg/L that were obtained from testing against 171 clinical isolates [43]. Its activity against A. baumannii was then testified by Yin et al., showing that ceftobiprole could inhibit 94.1% of carbapenem-susceptible A. baumannii at MIC50≤8 mg/L [45]. In the same study, the inhibitory effect against carbapenem-resistant A. baumannii was also assessed but limited to 5.3% [45].
Role of Intralesional Antibiotic for Treatment of Subretinal Abscess – Case Report and Literature Review
Published in Ocular Immunology and Inflammation, 2022
Saurabh Verma, Shorya Vardhan Azad, Pradeep Venkatesh, Vinod Kumar, Abhidnya Surve, Akshaya Balaji, Rajpal Vohra
Causative organism in our case was Citrobacter which was confirmed by the culture of the vitreous biopsy sample. Citrobacter is a gram-negative bacterium that commonly colonizes in human gastrointestinal tract and is known to cause meningitis, urinary tract infection, bacteremia, and gastrointestinal infections. Septic emboli from a renal abscess seems to be the most common source of endogenous endophthalmitis in such cases.11 Shetty et al. demonstrated that only 29–43% isolates of Citrobacter isolated from various clinical specimens are susceptible to third-generation cefalosporins such as ceftazidime and ceftriaxone which was administered to the patient for gram-negative coverage, which explains the lack of response to initial treatment.12,13 Primary cause of this resistance is the production of beta lactamase by these bacteria. Piperacillin and tazobactam combination is known to have good action against it which explains the resolution of infection on the administration of intralesional injection of this combination.14
Mortality associated with third generation cephalosporin-resistance in Enterobacteriaceae infections: a multicenter cohort study in Southern China
Published in Expert Review of Anti-infective Therapy, 2021
Jiancong Wang, Mouqing Zhou, Therese Hesketh, Evangelos I. Kritsotakis
The following indicator organisms in the Enterobacteriaceae family were included for analysis: E. coli, Klebsiella pneumoniae, Klebsiella spp., Enterobacter spp., Citrobacter spp., and other Enterobacteriaceae species (i.e. Morganella, Proteus, Providencia, Serratia, and Salmonella species). Microbiological identification and susceptibility testing were performed using VITEK® 2 (BioMérieux, Marcy l’Etoile, France). The breakpoints for minimal inhibitory concentration (MIC) were based on the US National Clinical and Laboratory Standards Institute guidelines (modified version based on M100-28th edition in 2017) [20]. The indicator antimicrobial for third-generation cephalosporin resistance was ceftriaxone, with an MIC≤1 defining susceptibility and an MIC ≥2 defining resistance.