Citrobacter ventriculitis in a neonate responsive to trimethoprim-sulfamethoxazole
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Citrobacter diversus causes serious central nervous system infections in newborns, often leading to brain abscesses. Trimethoprim-sulfamethoxazole proved effective in treating a neonate with meningitis and ventriculitis resistant to other antibiotics.
Area of Science:
- Neonatal infectious diseases
- Neuroscience
- Pharmacology
Background:
- Citrobacter species are increasingly recognized as a cause of central nervous system (CNS) infections in neonates.
- These infections, particularly brain abscesses, are associated with significant morbidity and mortality.
- Antibiotic resistance in Citrobacter CNS infections poses a therapeutic challenge.
Observation:
- A term male infant with meningo-myelocoele and hydrocephalus developed Citrobacter diversus meningitis and ventriculitis.
- Initial treatment with intraventricular amikacin failed to clear the infection or improve the clinical status.
- The patient's condition deteriorated despite standard antibiotic interventions.
Findings:
- Addition of intravenous trimethoprim-sulfamethoxazole to the treatment regimen led to clinical improvement.
- The ventricles were sterilized, and the infant experienced a full recovery.
- The identified Citrobacter diversus strain was susceptible to trimethoprim-sulfamethoxazole.
Implications:
- Trimethoprim-sulfamethoxazole represents a potentially valuable therapeutic option for neonatal CNS infections caused by susceptible Citrobacter species.
- This case highlights the importance of considering alternative antibiotics when initial therapies fail in neonatal meningitis and ventriculitis.
- Further investigation into the efficacy and safety of trimethoprim-sulfamethoxazole in neonatal CNS infections is warranted.
Abstract:
There are increasing reports of citrobacter central nervous system infections in neonates. These organisms cause brain abcesses in a high percentage of patients. They may be resistant to commonly used antibiotics. We report a term male infant with underlying meningo-myelocoele and hydrocephalus in whom Citrobacter diversus meningitis and ventriculitis developed. Initial antibiotic therapy including intraventricular amikacin failed to sterilize the ventricles or alter a deteriorating clinical course. Adding intravenous trimethoprim-sulfamethoxazole to the therapeutic regimen resulted in reversal of a progressively worsening condition and eventual recovery. Trimethoprim-sulfamethoxazole should be considered as a potentially useful alternative antibiotic for susceptible central nervous system infections.