The alarm comes back citrobacter at the Borgo Trento hospital in Verona. In fact, three premature newborns showed an abnormal result on the test for the search for Citrobacter koseri, the bacterium that had already been identified in the same hospital facility in 2020, again in the maternity ward, and which had infected a hundred subjects, causing 4 deaths and about ten cases of disability. This was reported by the Verona Integrated University Hospital (Aou), which however specified that one child has already been discharged, another has tested negative and the last one is still positive, but does not report symptoms of the infection.
“It is currently not possible to establish whether the bacterium identified is the same strain as 4 years ago, as the genomic investigation carried out requires longer times”, the Aou underlines in a note. But of what bacterium is this exactly?
What are citrobacters
Citrobacter are a genus of bacteria belonging to the same family as salmonella and escherichia, which can be found everywhere in the environment, in foods and as a component of our intestinal bacterial flora. However, the three main species of citrobacter, viz C. freundii, C. koseri e C. braakii., can cause serious infections, especially in the “fragile” categories, i.e. the elderly, newborns (especially premature ones) and immunocompromised people. Most of the infections, underlined by Higher Institute of Health (ISS), occurs in hospital environments, through contaminated food and objects, from person to person and from mother to child, during part.
In hospital, experts add, “the transmission it 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”.
Infection and symptoms
Citrobacter can cause infections of the urinary tract, respiratory tract, peritoneum, endocardium, meningitis and sepsis. And it is for this reason that the symptoms vary based on the organ/tissue affected. Between symptoms there is swelling, redness, pain and pus, high fever, difficulty breathing, cough, sputum, pneumonia, problems urinating, pain in the pelvic region, general malaise, chills, confusion, sepsis and septic shock. In the case of Citrobacter koseri the infection can lead to a particularly severe form of meningitis neonatal, “generally associated with necrotizing encephalitis and brain abscesses”, explains the ISS.
The bacterium, we read in a study published in the magazine Clinical Infectious Diseases causes the death of about a third of children with abscesses and half suffer damage to the central nervous system.
Diagnosis and treatment
To detect the presence of Citrobacter, a series of methods are used exams based on the site of the infection. Skin swabs, urine and blood tests and sputum tests can then be performed. To confirm the diagnosis and molecular and biochemical tests are subsequently performed to identify the serogroup. “For the treatment of Citrobacter infections the antibiotic or combination of antibiotics most appropriate is chosen based on the result of the antibiogram”, the experts comment. “It is important to perform 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 is currently 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”.
The epidemic of 2020
Four years ago, as we told you, there was an epidemic event, caused by Citrobacter koseri, in the same hospital, i.e. in the neonatal and pediatric intensive care departments of the Women’s and Children’s Hospital of Borgo Trento. In fact, from the data it emerged that since 2017 a total of 91 subjects had tested positive for the bacterium, 9 newborns had developed an invasive pathology due to the bacterium, of which 4 deceased and 5 with serious brain injuries. Subsequent investigations had detected contamination on the jet aerators of some taps inside the neonatal and pediatric intensive care unit and on the internal and external surfaces of feeding bottle.