TO Verona has been alerted again for Citrobacter, which infected around a hundred newborns at the Borgo Trento hospital between 2018 and 2020, resulting in 4 deaths and about ten children who suffered disabilities due to the infection. Last Friday, May 3, three premature newborns cared for at the Veneto facility presented an abnormal test result for the search for Citrobacter koseri and the memory returned to those days of fear.
The Verona Integrated University Hospital (AOU) reassured that the three children are well: one was discharged, another tested negative and the third remains positive, but without signs of infection. AND’ still too early, the Aoui specified, to establish whether the bacterium identified is the same strain as 4 years ago. The genomic investigation has been prepared, but requires longer times.
What is Citrobacter and what does it cause?
But what is citrobacter and what does it cause? How is it recognised? And how is it treated? “The Citrobacter genus – explains the Higher Institute of Health on the ‘ISSalute’ portal – includes bacteria that can be found everywhere in the environment, including water, and in foods. They are also a normal component of the intestinal bacterial flora. They can cause infections in vulnerable people such as newborns (particularly premature ones), elderly and immunocompromised individuals. In these subjects they can cause infections of the urinary tract, respiratory tract, wounds, bones, peritoneum, endocardium, meningitis and sepsis. The 3 main species that cause serious infections in humans are C. freundii, C. koseri and C. braakii. Most of these infections are acquired in hospitals, however, given the spread of the bacterium, they can also become infected outside. outside” of a health facility, especially “through the ingestion of contaminated food, from mother to child during childbirth, direct person-to-person contact, contact with contaminated surfaces or objects”. In hospital “transmission can also occur through contact with healthcare workers, especially through hands if not properly washed and disinfected”, or “indirect contact through contaminated objects or surfaces”.
Symptoms
What are the symptoms? “The disorders caused by Citrobacter infections are closely linked to the affected organ: redness, swelling, localized pain and pus, in skin infections and in deep ones such as osteomyelitis; high fever, difficulty breathing, cough, sputum, weakness and decay of general conditions, in pneumonia; difficulty urinating, frequent urge, urgency to urinate, pain while urinating, pain in the pelvic and lumbar region, blood in the urine, purulent urine, fever, in urinary infections; , general malaise, muscle pain, chills and confusion, in sepsis; lowering of blood pressure, in case of worsening of sepsis and septic shock; neonatal meningitis caused by C. koseri, particularly severe form, generally associated with necrotizing encephalitis and abscesses brain”, lists the ISS.
“When a Citrobacter infection is suspected – continues the Higher Institute of Health – it is essential to ascertain the presence of the bacteria in the organism through different analyzes depending on the site of the infection: skin swab; urinalysis and urine culture; blood analysis blood and blood culture; sputum examination. Subsequent biochemical and molecular tests confirm the diagnosis and allow identification of the serogroup, a classification criterion which is based on the different proteins (O antigen) on the surface of the bacteria, and is useful for making a diagnosis. more precise and to study hospital epidemics”.
Therapy
What is the therapy? “For the treatment of Citrobacter infections – explains the ISS – the most appropriate antibiotic or combination of antibiotics is chosen on the basis of the result of the susceptibility test. It is important to carry out the susceptibility test because Citrobacter is resistant to penicillins and various combinations of beta-lactam antibiotics. Furthermore, there are bacterial strains resistant to multiple classes of antibiotics, for which the only effective antibiotic at the moment is colistin. Colistin must be prescribed by the doctor who checks the general state of the patient and the possible onset of toxic effects during treatment”.
“Bacteria of the Citrobacter genus – highlights the ISS – cause serious infections and, sometimes, epidemics in hospital settings. In order to prevent and control the transmission of infections within hospitals, the following are important: surveillance of infections and the rapid identification and control of epidemics; prevention of infections associated with specific procedures, reducing the execution of unnecessary ones and choosing safer medical devices; correct use of antibiotics and disinfectants; frequent and correct washing of environments; Correct hand washing – the Institute’s experts point out – is a very effective practice for the prevention of Citrobacter infections and in general, and can be practiced by everyone both in hospital and outside, at home and at work. “.
