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• W4285196127 abstract "Dear Editor, Citrobacter braakii, a gram-negative anaerobic bacillus, belongs to the family Enterobacteriaceae. It is found as an environmental contaminant or colonizer. But it can cause multiorgan dysfunctions in immunocompromised patients.[1] Multidrug-resistant strains have also been recognized, and hence timely recognition and treatment are essential. We report a case of carbapenem-resistant Citrobacter braakii bacteremia. This clinical scenario can aid primary healthcare professionals in making informed treatment decisions, when faced with this relatively uncommon pathogen. A 43-year-old male with no comorbidity presented to the emergency department with a history of fever for the last 5 days, vomiting, and abdominal pain. The fever was low grade, continuous, and relieved with antipyretics. The patient presented to the emergency because of worsening vomiting and abdominal pain. Initially, the patient was managed with inj. ondansetron and inj. paracetamol, intravenous fluids. Ultrasonography of the abdomen was suggestive of acute pancreatitis. The patient was managed conservatively with intravenous fluids. The patient had persistent vomiting and pain, so an upper GI endoscopy was performed, which showed esophageal erosions. To maintain enteral nutrition for the patient, a feeding jejunostomy was done. The patient developed hypotension and respiratory distress in the immediate postoperative period and hence was transferred to ICU. Fluid resuscitation was done, and the patient was started on vasopressors. The patient was put on noninvasive ventilation because of respiratory distress. Routine blood investigations and paired blood cultures were taken. The patient was started empirically on inj. meropenem 1 g TDS. Blood cultures showed gram-negative coliform bacilli, identified as Citrobacter braakii. The organism was sensitive to amikacin, gentamicin, and tobramycin and resistant to beta-lactam and carbapenems. The antibiotic was upgraded to extended infusion meropenem 2 g TDS with inj. amikacin 750 mg OD. Gradually, the patient showed clinical improvement and was weaned off the ventilator and shifted to ward on day 5 of ICU. Citrobacter can cause life-threatening infection, especially in immunocompromised patients. Samonis et al.[2] have reported the incident of Citrobacter septicemia—C. freundii (71.8%), C. koseri (23.1%), and C. braakii (3.8%). The common types of infections caused by Citrobacter are urinary tract infections (52.6%), intra-abdominal (14.1%), surgical site (7.7%), soft tissue (6.4%), and respiratory tract infections (6.4%).[2] Septicemia due to C. braakii is very rare. Citrobacter is an emerging nosocomial pathogen with an increase in resistance pattern. This case highlights the rarity and importance of Citrobacter as a cause of bacteremia. Financial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest." @default.
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• W4285196127 date "2022-01-01" @default.
• W4285196127 modified "2023-09-25" @default.
• W4285196127 title "Bacteremia due to carbapenem-resistant Citrobacter braakii" @default.
• W4285196127 cites W2003798904 @default.
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• W4285196127 doi "https://doi.org/10.4103/jfmpc.jfmpc_1685_21" @default.
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