447. Citrobacter Bacteremia in Patients with Solid Tumor Patients at a Tertiary Care Cancer Center in Japan
Session: Poster Session: Hospital-acquired and Transplant Infections
Friday, October 30, 2009: 12:00 AM
Room: Poster Hall A
Background: The characteristics of Citrobacter bacteremia in patients with solid tumors have scarcely been described. Based on our experience, we reviewed the characteristics of Citrobacter bacteremia in patients with solid tumors as compared with those in other populations previously reported in the literature.
Methods: We reviewed the hospital records of solid tumor patients whose blood cultures yielded Citrobacter species at the Shizuoka Cancer Center (557-bedded tertiary care cancer center in Japan) from September 1, 2002, through August 31, 2008.
Results: Twenty-five positive blood cultures were documented in 18 patients. There were 14 male and 4 female patients, and the median age of the patients was 63.6 years (range, 36-85 years). All of the 18 patients had intra-abdominal solid tumors (gastric cancer in 6, bile duct cancer in 4, pancreatic cancer in 2, uterine cancer in 2, colon cancer in 1, rectal cancer in 1, ovarian cancer in 1, and ureter cancer in 1). Twelve patients had underlying hepatobiliary disease (hepatic metastases in 5, hepatic abscesses in 3) and 10 patients had underlying gastrointestinal complication due to cancer (peritoneal dissemination in 5, bowel obstruction in 3). The anatomical focus of the infection could be determined in 12 of the patients (66.7%). The most common site of infection was intra-abdominal (cholangitis in 3, gastrointestinal tract in 2, hepatic abscesses in 1). Isolates of Citrobacter species from 5 of the patients (27.8%) were resistant to cefotaxime and ceftazidime. All the isolates were susceptible to cefepime, quinolones and amynoglycosides. Seven of the 18 patients (38.9%) died within 30 days, of which five died of the bacteremia.
Conclusion: Citrobacter bacteremia in patients with solid tumors may be associated with problems in the abdominal cavity. Resistance to third-generation cephalosporins is an important consideration in the selection of empiric therapy.
Takahiro Fujita, MD1, Yoshiaki Gu, MD2, Naoki Kishida, MD3, Norio Ohmagari, MD3, Keiji Okinaka, MD3, Tomoaki Sato, Medical Technologist2 and  K. Okinaka, None..
N. Kishida, None..
T. Fujita, None..
Y. Gu, None..
T. Sato, None..
N. Ohmagari, None., (1)Shizuoka cancer center, Sunto-gun, Japan, (2)Shizuoka cancer center, (3)Shizuoka Cancer Center, Shizuoka, Japan