Multidrug resistant citrobacter: an unusual cause of liver abscess

Area of Science:

• Hepatology
• Infectious Diseases
• Microbiology

Background:

• Pyogenic liver abscess (PLA) is an uncommon hepatic infection, typically caused by Gram-negative aerobes like E. coli.
• While often treatable with antibiotics due to high antimicrobial susceptibility, PLA can present with non-specific symptoms such as fever and abdominal pain.
• The etiology of PLA is diverse, including biliary, portal, arterial, or traumatic origins, with many cases remaining cryptogenic.

Observation:

• This report details a rare case of PLA.
• The abscess was caused by multidrug-resistant Citrobacter freundii, an organism not commonly implicated in PLA.
• The patient presented with typical, yet elusive, symptoms of liver abscess.

Findings:

• Isolation of multidrug-resistant Citrobacter freundii as the causative agent of PLA.
• This finding challenges the typical etiological profile of PLA, which usually involves more common Gram-negative bacteria.
• The case underscores the evolving landscape of microbial pathogens responsible for liver infections.

Implications:

• Highlights the importance of considering unusual pathogens, such as multidrug-resistant Citrobacter freundii, in the differential diagnosis of PLA.
• Suggests that current antimicrobial susceptibility patterns for common PLA pathogens may not always apply.
• Emphasizes the need for vigilant microbiological investigation and tailored antimicrobial therapy in complex liver abscess cases.