Sepsis with Citrobacter diversus in sick newborns

Area of Science:

• Neonatal Medicine
• Infectious Diseases
• Microbiology

Background:

• Citrobacter diversus is an emerging cause of neonatal meningitis and abscesses.
• This bacterium is associated with high mortality and poor outcomes in newborns.
• The study focuses on C. diversus septicemia without meningitis in critically ill neonates.

Purpose of the Study:

• To report the clinical experience with C. diversus septicemia in critically ill newborns.
• To compare C. diversus sepsis with Escherichia coli sepsis in neonates.
• To analyze the antimicrobial resistance patterns of C. diversus.

Main Methods:

• Retrospective case series of 13 neonates with C. diversus septicemia.
• Comparison with a matched group of neonates with E. coli sepsis.
• Analysis of clinical data, including birthweight, gestational age, and complications.
• Antimicrobial susceptibility testing of C. diversus isolates.

Main Results:

• C. diversus septicemia occurred in critically ill neonates with a mean birthweight of 1530 gm and gestational age of 31.3 weeks.
• No significant differences were found in perinatal complications, white blood cell counts, platelet counts, or mortality rates between C. diversus and E. coli sepsis groups.
• Hypotension was more frequent in E. coli sepsis.
• All C. diversus isolates were resistant to gentamicin but sensitive to cephalosporins.
• C. diversus was identified as the most common nosocomial pathogen in the unit.
• Plasma profile analysis suggested two distinct C. diversus strains were involved.

Conclusions:

• C. diversus is a significant nosocomial pathogen in neonatal intensive care units.
• Treatment for suspected C. diversus septicemia should include cephalosporins due to aminoglycoside resistance.
• Early recognition and appropriate antibiotic therapy are crucial for improving outcomes in neonates with C. diversus infections.