Massive Liver Abscess Caused by Multidrug Resistant Citrobacter freundii

Pyogenic liver abscess is a disease entity that may follow infections of the biliary tract, blood stream and intra abdominal conditions like appendicitis, diverticulitis etc. Co- morbid conditions like diabetes mellitus, renal disease, malignancy, immune suppression etc. may contribute to the development of an abscess and affect the overall outcome of liver abscess as well. Escherichia coli and Klebsiellapneumoniae have been reported to be the most common isolations from these cases. Citrobacter infections usually occur in patients with some underlying co- morbidities and mostly in hospitalized patients. Recently, an increased emergence of multi- drug resistant strains is presenting a challenge to clinicians and microbiologists. Here, we report a case of massive liver abscess in an immunocompetent patient caused due to Citrobacterfreundii resistant to gentamicin, ciprofloxacin, cotrimoxazole, amikacin, ceftriaxone and piperacillin-tazobactam. It showed in vitro sensitivity to meropenem and aztreonam only.