Multidrug-resistant nosocomial Citrobacter in a hospital in Kathmandu.

Citrobacter sp. is a commensal flora and an infrequent nosocomial pathogen to cause nuisance in hospital settings. Recently, the isolation of this pathogen in health care setting is rising and the multidrug resistant strains are emerging. This pathogen cause wide array of infections and the mortality rate is unexpectedly high of 30.0-60.0%. Extended spectrum cephalosporins have been used to treat this pathogen and due to the emergence of resistant strains to these drugs newer treatment protocols have to be devised. Epidemiology and antibiotic susceptibility pattern of clinical isolates of Citrobacter sp. isolated in a hospital were investigated. Specimens were collected from patients and implicated pathogens were isolated. Disk diffusion test was performed on these isolates and resistant patterns were. Antibiogram typing was used to resolve the clones of the isolated bacteria. The results showed that Citrobacter sp. was highly prevalent and commonly isolated from the sputum sample of patients diagnosed as Chronic Obstructive Pulmonary Disease (COPD). The antibiogram pattern suggested the circulation of three clones of Citrobacter sp. They were multidrug resistant and were sensitive to only cefoperazone and sulbactam suggesting the production of â-lactamse inhibitors sensitive molecular class A and D extended spectrum â-lactamases (ESBL). In conclusion, although, ESBL producers are always treated with carbapenems, we recommend to use combination therapy of â-lactam and â-lactamse inhibitors to treat this multidrug resistant Citrobacter sp. and carbapenems should be kept as a reserve drug and we should aim to prevent the spread of this resistant pathogen between different patients to decrease the morbidity and mortality associated with this pathogen.