BACTEREMIA DUE TO CITROBACTER SPECIES - SIGNIFICANCE OF PRIMARY INTRAABDOMINAL INFECTION

From 1982 to 1994, 45 patients (1.22 episodes per 10,000 discharged pa tients) were treated for citrobacter bacteremia at National Taiwan Uni versity Hospital (Taipei). All patients had at least one underlying di sease. Citrobacter bacteremia most commonly occurred in patients with malignancies (48.9%) or hepatobiliary stones (22.2%). Intraabdominal t umors comprised the majority (59.1%) of malignancies. Bacteremia commo nly originated from sites such as the abdominal cavity (51.1%), urinar y tract (20%), and lung (11.1%). Polymicrobial bacteremia was diagnose d in 15 patients (33.3%); for nine (60%) of these patients, the source of the infection was intraabdominal. Prior treatment with a third-gen eration cephalosporin was significantly associated (P < .01) with the development of multidrug resistance among the isolates. The mortality associated with citrobacter bacteremia was 17.8%. Poor prognostic fact ors included pneumonia, altered mental status on presentation, hypothe rmia, oliguria, septic shock, deterioration in mental status, hyperbil irubinemia, azotemia, and thrombocytopenia. Combination therapy, as co mpared with other regimens, improved the outcome of citrobacter bacter emia.