Citrobacter werkmanii-Introduction, Morphology, Pathogenicity, Lab Diagnosis, Treatment, Prevention, and Keynote

Citrobacter werkmanii -Introduction, Morphology, Pathogenicity, Lab Diagnosis, Treatment, Prevention, and Keynote

Introduction

Citrobacter werkmanii is a gram-negative bacterium commonly found in the intestinal tract of humans and animals. It is an opportunistic pathogen, typically causing infections in immunocompromised individuals. It can lead to urinary tract infections (UTIs), wound infections, and bacteremia. Additionally, it is known for antibiotic resistance, complicating treatment. Identifying C. werkmanii is crucial for appropriate therapeutic management, particularly in hospital settings where it can cause serious infections in vulnerable patients.

Morphology

Citrobacter werkmanii is a gram-negative, rod-shaped bacterium, typically measuring 0.5 to 0.8 micrometers in diameter. It is motile, possessing peritrichous flagella that enable movement. On agar plates, it forms pale, moist colonies. The bacterium is non-spore-forming and ferments glucose, producing acid without gas. It is typically oxidase-negative and indole-positive, characteristics useful for its identification. Additionally, it grows well under aerobic and anaerobic conditions, often showing distinct growth patterns on different media.

Pathogenicity

Citrobacter werkmanii is an opportunistic pathogen, that primarily affects immunocompromised individuals. It is commonly associated with urinary tract infections (UTIs), wound infections, and bacteremia. The bacterium’s ability to form biofilms allows it to persist in medical devices, leading to chronic diseases. Additionally, C. werkmanii can exhibit antibiotic resistance, particularly to beta-lactams, complicating treatment options. In hospital settings, it poses a significant risk, especially in patients with catheters or those undergoing surgical procedures. Early identification and antimicrobial susceptibility testing are critical to managing infections caused by this pathogen effectively.

Lab Diagnosis

The laboratory diagnosis of Citrobacter werkmanii begins with gram staining, where it appears as gram-negative rods. C. werkmanii is cultured on MacConkey agar and CLED agar, where it forms pale colonies. Biochemical tests such as glucose fermentation, indole production, and urease testing help differentiate C. werkmanii from other pathogens. It is typically oxidase-negative and non-lactose fermenting. API 20E or Vitek 2 systems may be used for more precise identification. Motility testing confirms its peritrichous flagella. Antimicrobial susceptibility testing is essential to guide appropriate therapy, as C. werkmanii often exhibits antibiotic resistance. Moreover, serological methods or PCR can be used for further confirmation, especially in complex cases. These diagnostic steps ensure accurate identification and treatment of infections caused by this bacterium.

Treatment

The treatment of Citrobacter werkmanii infections typically involves the use of antibiotics, guided by susceptibility testing. Carbapenems, such as imipenem or meropenem, are often effective against resistant strains. Fluoroquinolones, like ciprofloxacin, and aminoglycosides are alternatives, depending on resistance patterns. Trimethoprim-sulfamethoxazole may also be used, especially in urinary tract infections (UTIs). In severe cases, such as bacteremia or wound infections, combination therapy may be required. Beta-lactam antibiotics may be ineffective due to antibiotic resistance in some strains. Infection control measures, such as proper sterilization of medical devices, are crucial to prevent transmission. Monitoring underlying conditions, such as catheter use or immunocompromised status, is essential in reducing the risk of recurrence. Early intervention and appropriate therapy are vital to improving patient outcomes and preventing complications.

Prevention

Prevention of Citrobacter werkmanii infections requires strict infection control measures in healthcare settings. First, hand hygiene is essential to prevent transmission. Additionally, proper sterilization of medical devices, such as catheters and intravenous lines, reduces the risk of device-associated infections. Antibiotic stewardship is critical to limit the development of antibiotic resistance. Routine screening of high-risk patients, particularly those with immunocompromised conditions, helps identify C. werkmanii early. Moreover, proper wound care and early treatment of infections prevent complications. Isolation protocols may be necessary for infected patients to avoid spreading the bacterium. Finally, educating healthcare staff on these preventive measures ensures adherence and reduces the risk of outbreaks.

Keynotes

  1. Citrobacter werkmanii is a gram-negative rod-shaped bacterium found in the intestinal flora.
  2. It is an opportunistic pathogen, often infecting immunocompromised individuals.
  3. C. werkmanii causes urinary tract infections (UTIs), wound infections, and bacteremia.
  4. It exhibits antibiotic resistance, particularly to beta-lactams, complicating treatment.
  5. The bacterium is motile and produces biofilms, aiding persistence in medical devices.
  6. Gram staining reveals gram-negative rods, which is useful for initial identification.
  7. Biochemical tests confirm glucose fermentation, indole production, and urease activity.
  8. werkmanii grows on MacConkey agar, CLED agar, and other selective media.
  9. Early diagnosis and antimicrobial susceptibility testing are crucial for proper treatment.
  10. Prevention requires infection control, proper sterilization, and antibiotic stewardship in healthcare settings.

Further Readings

  1. https://pmc.ncbi.nlm.nih.gov/articles/PMC10457828/
  2. https://microbialcellfactories.biomedcentral.com/articles/10.1186/1475-2859-13-70
  3. https://bmcgenomics.biomedcentral.com/articles/10.1186/s12864-017-4157-9
  4. https://journals.asm.org/doi/10.1128/aac.01042-07
  5. https://www.ncbi.nlm.nih.gov/Taxonomy/Browser/wwwtax.cgi?mode=Info&id=67827
  6. https://www.mdpi.com/1422-0067/19/9/2644
  7. https://academic.oup.com/femsle/article-abstract/215/1/81/505214?redirectedFrom=fulltext
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