Sepsis with Citrobacter diversus in sick newborns.

Citrobacter diversus has been increasingly recognized as a cause of life-threatening neonatal meningitis with frequent abscess formation. This condition is associated with high mortality and extremely poor prognosis. We report our experience with C. diversus septicemia without meningitis in critically ill newborns. Thirteen patients with mean birthweight 1530 +/- 925 gm and mean gestational age 31.3 +/- 3.5 weeks were affected. They were compared with a group of infants affected by Escherichia coli sepsis, matched for weight, gestational age, and age at diagnosis. The groups did not differ in the incidence of perinatal complications, peripheral white blood cells, platelet count, and death rate. Hypotension was more frequently found in E. coli sepsis (p less than 0.05). All C. diversus isolates were resistant to gentamicin but sensitive to cephalosporins. C. diversus has become the most common nosocomial pathogen in our unit. Plasma profile analysis suggests that two different strains of C. diversus were involved in the outbreak reported here. Therapy for suspected C. diversus septicemia should include cephalosporins whenever resistance to aminoglycosides is demonstrated.