CTX-M-14 β-lactamase-producing Citrobacter freundii isolated in Venezuela

Extended-spectrum β-lactamases (ESBLs) create significant therapeutic problems by inactivating almost all β-lactams except cephamycins and carbapenems. Following the detection of the first ESBL, TEM and SHV-derived ESBLs evolved and disseminated globally up to the late 1990s. Since then, a new epidemiological situation lead to a predominant increase of CTX-M derived enzymes [1]. Infections caused by ESBL-producing Enterobacteriaceae have mostly been described as hospital-acquired, associated with health care facilities [2], and, with increasing frequency, isolated from patients from both extended-care facilities and community-onset diseases [3,4]. Citrobacter freundii is an opportunistic pathogen that can cause diarrhea, septicemia, meningitis, and respiratory and urinary tract infection, especially in high-risk groups [5]. Multidrug resistance in Citrobacter spp. is a growing concern all over the world, and extended-spectrum cephalosporins are currently used to treat infections caused by these microorganisms. Numerous international molecular studies have also described the occurrence of various CTX-M types in species of Citrobacter, CTX-M-9 in the United Kingdom [6], CTX-M-30 in Canada [7], CTX-M-3 in Korea [8], CTX-M-2 in Japan [9], CTX-M-14 in China [10], and CTX-M-15 in India [11]. However, the distribution of CTX-M producers among community-onset pathogens from South America, especially in Venezuela, remains scarcely known. In this report, we describe a clinical isolate of C. freundii with reduced susceptibility to extended-spectrum cephalosporins that produces a CTX-M-14 type β-lactamase, from a woman with cystocele and urinary infection.In June 2010, a 47-year-old woman was assisted in private consulting with a history of grade II cystocele and recurrent urinary tract infection since December 2009. One cephalosporin-resistant strain of Citrobacter freundii LM07/10 was isolated from an urine sample. The strain was identified using conventional biochemical test