Do we need to treat Citrobacter diversus (Citrobacter diversus) urinary tract infection (UTI)?

From the Guidelines

Treatment of Citrobacter diversus urinary tract infection (UTI) is recommended, especially if the patient is symptomatic or has underlying complicating factors. The European Association of Urology guidelines on urological infections suggest that the microbial spectrum of complicated UTIs, which may include Citrobacter diversus, is greater than for uncomplicated UTIs, and antimicrobial resistance is more likely 1. Key factors to consider in the management of complicated UTIs include:

• Obstruction at any site in the urinary tract
• Recent history of instrumentation
• Health care–associated infections
• Multidrug-resistant organisms isolated Given these considerations, appropriate management of the urological abnormality or the underlying complicating factor is mandatory, along with optimal antimicrobial therapy. The choice of antibiotic should be guided by local resistance patterns, specific host factors, and susceptibility testing, with common options including fluoroquinolones, trimethoprim-sulfamethoxazole, or nitrofurantoin. Treatment duration typically ranges from 7 to 14 days, depending on the severity of the illness and the presence of underlying abnormalities, with the goal of closely relating the treatment duration to the resolution of the underlying condition 1. In cases where short-course treatment is desirable due to relative contraindications to the antibiotic administered, a shorter treatment duration (e.g., 7 days) may be considered when the patient is haemodynamically stable and has been afebrile for at least 48 hours 1.

From the FDA Drug Label

Urinary Tract Infections caused by Escherichia coli, Klebsiella pneumoniae, Enterobacter cloacae, Serratia marcescens, Proteus mirabilis, Providencia rettgeri, Morganella morganii, Citrobacter diversus, Citrobacter freundii, Pseudomonas aeruginosa, methicillin-susceptible Staphylococcus epidermidis, Staphylococcus saprophyticus, or Enterococcus faecalis

Yes, we need to treat Citrobacter diversus urinary tract infection (UTI) because ciprofloxacin is indicated for the treatment of UTIs caused by Citrobacter diversus 2.

From the Research

Treatment of Citrobacter diversus Urinary Tract Infections (UTIs)

• Citrobacter diversus, now known as Citrobacter koseri, is a gram-negative bacillus that can cause urinary tract infections, particularly in immunocompromised patients or those with underlying medical conditions 3, 4, 5.
• The treatment of UTIs caused by Citrobacter species is crucial due to their potential to develop resistance to multiple antibiotics 6, 4, 5.
• According to the available evidence, treatment options for UTIs due to Citrobacter species may include:
  • Nitrofurantoin
  • Fosfomycin
  • Pivmecillinam
  • Fluoroquinolones
  • Cefepime
  • Piperacillin-tazobactam
  • Carbapenems 6, 5
• It is essential to note that the choice of antibiotic therapy should be guided by the results of antimicrobial susceptibility testing and local resistance patterns 6, 4, 5.
• In cases of multidrug-resistant Citrobacter species, combination antibiotic therapy or the use of newer antimicrobial agents may be necessary 6, 4.

Clinical Relevance of Citrobacter diversus Infections

• Citrobacter diversus infections, including UTIs, can be clinically significant and require prompt treatment 7, 5.
• The clinical characteristics of Citrobacter species infections, including UTIs, can vary depending on the underlying medical conditions of the patient and the presence of other comorbidities 5.
• The outcomes of Citrobacter species infections, including UTIs, can be influenced by factors such as the severity of the infection, the presence of underlying medical conditions, and the appropriateness of antibiotic therapy 5.