Related Experiment Videos
Adult Citrobacter freundii meningitis: case report
Y C Chuang1, W N Chang, C H Lu
1Department of Neurology, Chang Gung Memorial Hospital, Kaohsiung, Taiwan, R.O.C.
Abstract:
Citrobacter is a distinct group of Gram-negative bacilli belonging to the Enterobacteriaceae family. Central nervous system (CNS) infections due to Citrobacter are uncommon, though they occur more frequently in neonates and young children. In adults, Citrobacter meningitis is extremely unusual with only 6 cases reported in the literature before 1998. This rare CNS infection has been seen in patients with head trauma, following neurosurgical procedures, and in those who are immunocompromised. Of the patients in the 6 reported cases, only one developed multi-antibiotic resistant Citrobacter CNS infection. Adding to this small number of reported cases, we report an adult case of post-neurosurgical meningitis and subdural empyema caused by multi-antibiotic resistant Citrobacter freundii and also review the literature related to this infection. Antimicrobial therapy with imipenem and third-generation cephalosporins failed to result in cerebrospinal fluid sterilization in our patient. Because of the use of broad-spectrum antibiotics, multi-antibiotic resistant Citrobacter species have developed in this nosocomial CNS infection and now present a therapeutic challenge. Therefore, further clinical studies are needed to determine updated therapeutic modalities for treating this life-threatening infection.
Insights
Multi-antibiotic resistant Citrobacter freundii caused a rare adult meningitis and subdural empyema post-neurosurgery. Standard antibiotics failed, highlighting a significant therapeutic challenge for this life-threatening infection.
Area of Science:
- Medical Microbiology
- Infectious Diseases
- Neuroscience
Background:
- Citrobacter are Gram-negative bacilli in the Enterobacteriaceae family.
- Central nervous system (CNS) infections from Citrobacter are rare, particularly in adults.
- Adult Citrobacter meningitis is exceptionally uncommon, with few cases reported historically.
Observation:
- This case involves an adult with post-neurosurgical meningitis and subdural empyema.
- The infection was caused by multi-antibiotic resistant Citrobacter freundii.
- Initial antimicrobial therapy with imipenem and third-generation cephalosporins was ineffective in sterilizing cerebrospinal fluid.
Findings:
- The patient developed a nosocomial CNS infection with multi-drug resistant Citrobacter.
- Broad-spectrum antibiotic use contributed to the development of antibiotic resistance.
- This resistant strain presented a significant therapeutic challenge.
Implications:
- This case underscores the growing threat of multi-antibiotic resistant organisms in healthcare settings.
- Effective treatment strategies for resistant Citrobacter CNS infections are urgently needed.
- Further clinical research is essential to establish updated therapeutic guidelines for these severe infections.