Citrobacter SPECIES AS AN EMERGING PATHOGEN IN INFECTED WOUNDS AT A TERTIARY CARE INSTITUTE OF NORTH WEST INDIA

Background: Citrobacter spp are becoming a cause for concern as they are causative agents in different types of wounds. Development of wound infection depends upon interplay of many factors and spread of MDR pathogens is adding new dimension to the problem in poor- resource countries.

Aims: The present study was undertaken to determine the prevalence of Citrobacter spp in infected wounds and antimicrobial resistance pattern, with special focus on multi drug resistance encountered.

Methodology: A retrospective analysis was carried out to determine the prevalence and antibiogram of Citrobacter species in infected wound specimens including pus, debrided tissues, aspirates and swabs received from the inpatient and outpatient departments of Bhagat Phool Singh (BPS), Govt. Medical College (GMC) Khanpur Kalan in the Department of Microbiology, from February 2013 to December 2013.

Results: The prevalence of Citrobacter species as gram negative pathogen from 668 samples analyzed was 19.46% (43), out of which 30 (69.77%) were C. freundii and 13 (30.23%) C. koseri isolates. Among various clinical departments, maximum isolates were recovered from orthopedics 18 (41.86%) followed by general surgery 07(16.28%). The rate of isolation was highest from trauma wounds (27.91%) followed by non-healing ulcer (20.93%) and abdominal surgery wound (16.28%). Overall MDR isolates were 26 (60.47%), which were predominant in orthopedics (34.61%), general surgery (19.23%), obstetrics/gynecology (11.54%), labor room (11.54%) and SICU (11.54%). As regards type of wound, MDR isolates were in preponderance among trauma (30.77%) and abdominal surgery infected wounds (23.08%). Imipenem, Piperacillin/tazobactam, Doxycycline and Amikacin with sensitivity of 79.07%, 58.14%, 58.14% and 53.49% respectively, remained the most efficacious drugs.

Conclusion: The prudent use of prophylactic antibiotics and organized system of wound surveillance remains the most effective means of reducing wound infection rate to a minimum level. Multi drug resistance can be linked to massive usage of broad spectrum antibiotics that is neither tailored nor monitored which can add to cost and complications associated with procedures and treatment.