The following is a summary of “Epidemiology of Citrobacter spp. infections among hospitalized patients: a systematic review and meta-analysis,” published in the July 2024 issue of Infectious Disease by Fonton et al.
Researchers conducted a retrospective study of patients in hospitals to assess the prevalence, resistance patterns, and role in hospital outbreaks of Citrobacter spp. infections.
They conducted a systematic review and meta-analysis (PROSPERO registration Jan-2023) encompassing Embase, Medline, and grey literature studies, focusing on patients in hospitals with Citrobacter spp. infections and nosocomial outbreaks for Citrobacter spp. (2000 and 2022). The observational, interventional, surveillance studies, and outbreak reports were included. Key outcomes included infection frequency among patients in hospitals and percentages of 3rd generation cephalosporin and/or carbapenem resistance. Pooled estimates were generated using random-effects models, and bias risk and reporting quality of outbreaks were assessed.
The results showed a screening of 1,609 deduplicated publications, an assessment of 148 full-texts, and including 41 studies (15 observational, 13 surveillance, and 13 outbreak studies). Citrobacter spp. Urinary tract- and bloodstream infections were most frequently reported, with Citrobacter freundii as the primary causative species. Hospital-acquired infection occurred in 85% (838/990) of patients in hospitals with Citrobacter infection. Post-2010, an increasing number of patients with Citrobacter spp. infections were reported in observational studies. Pooled frequency estimates for Citrobacter spp. infections could not be generated due to data limitations. The pooled prevalence of ESBL and carbapenemase producers among Citrobacter isolates was 22% (95%CI 4–50%, 7 studies) and 18% (95%CI 0–63%, 4 studies). After 2016, there was an increase in reported Citrobacter outbreaks. The infection/colonization ratio was 1:3, and the case-fatality ratio was 7% (6/89 patients). Outbreak sources included sinks, toilets, contaminated food, and injection material. Preventive measures like environmental cleaning, patient isolation, and hand hygiene were implemented. Control was achieved in seven out of 13 outbreaks (54%).
Investigators concluded that Citrobacter spp. are increasingly concerning in hospitals due to their prevalence, ability to spread in outbreaks, and resistance to multiple drugs, emphasizing the need for greater awareness and monitoring.
Source: bmcinfectdis.biomedcentral.com/articles/10.1186/s12879-024-09575-8