الفهرس 
Introduction and Aim of WorkOnly 14 pages are availabe for public view
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Abstract
Citrobacter species are members of the normal intestinal flora of humans and animals. Eleven distinct genomospecies had been established. Many of these microorganisms used to be dismissed as harmless commensals. The role of Citrobacter species in human disease is now known to be increasing. Most infections involved the urinary tract, the respiratory tract, soft tissue or skin infections, central venous system and blood (bacteremia). This study was extended over a period of fifteen months, from first of June 2003 to end of August 2004; clinical specimens were collected from 4133 selected patients with suspected nosocomial infections, admitted to different wards of MUHs. Cultures yielded 1582 different nosocomial pathogens. The aim of this work was to study the role of the Citrobacter species as pathogens involved in different types of nosocomial infections in Mansoura University Hospitals, with special emphasis on their different species, their resistance to antibiotics, and their gb slactamase production. All samples were cultured on blood agar, MacConkey agar and chocolate agar followed by colonial identification, Gram stain, microscopic examination, and biochemical reactions for identification of Citrobacter. API 20E was used to confirm identification of Citrobacter and to detect different species of Citrobacter. Antibiogram using Kirby Bauer method was done to study the antibiotic susceptibility, typing, and detection of the multidrug resistance of the Citrobacter. gbslactamase production of the Citrobacter was detected using the nitrocefin test. This study revealed the following results: Citrobacter is emerging as important nosocomial pathogen in MUHs. In the present study 27Citrobacter isolates were identified out of 1852 positive culture results representing 1.7% of the total isolates. Blood, urine and stoool samples were the most common sources of Citrobacter. Extremes of age, idweiiing devices and Malignancy are among the risk factors for Citrobacter acquisition and imipenem is the most effective antibiotic against it . The most common species were C. freundii, C. koseri and only one C. braaki. In blood stream infections, theree were poolymicrobial Citrobacter infections together with Klebsiella, E. coli, and S. aureus. There are multidrug resistance by 59.5%. Citrobacters are important betalactamase producers.