Genetic Diversity, Multidrug Resistance, and Virulence of Citrobacter freundii From Diarrheal Patients and Healthy Individuals

Abstract

<b>Objectives:</b><i>Citrobacter freundii</i> is a frequent cause of nosocomial infections and a known cause of diarrheal infections, and has increasingly become multidrug resistant (MDR). In this study, we aimed to determine the genetic diversity, the antimicrobial resistance profiles and <i>in vitro</i> virulence properties of <i>C. freundii</i> from diarrheal patients and healthy individuals. <b>Methods:</b> 82 <i>C. freundii</i> isolates were obtained from human diarrheal outpatients and healthy individuals. Multilocus Sequence Typing (MLST) of seven housekeeping genes was performed. Antimicrobial susceptibility testing was carried out using the disk diffusion method according to the Clinical and Laboratory Standards Institute (CLSI) recommendations. Adhesion and cytotoxicity to HEp-2 cells were assessed. PCR and sequencing were used to identify <i>bla</i>_CTX-M<i>, bla</i>_SHV, <i>bla</i>_TEM, <i>qnrA, qnrB, qnrS, qnrC, qnrD, aac(6')-Ib-cr</i>, and <i>qepA</i> genes. <b>Results:</b> The 82 <i>C. freundii</i> isolates were divided into 76 sequence types (STs) with 65 STs being novel, displaying high genetic diversity. Phylogenetic analysis divided the 82 isolates into 5 clusters. All 82 isolates were sensitive to imipenem (IPM), but resistant to one or more other 16 antibiotics tested. Twenty-six isolates (31.7%) were multidrug resistant to three or more antibiotic classes out of the 10 distinct antibiotic classes tested. Five MDR isolates, all of which were isolated from 2014, harbored one or more of the resistance genes, <i>bla</i>_TEM-1, <i>bla</i>_CTX-M-9, <i>aac(6')-Ib-cr, qnrS1, qnrB9</i>, and <i>qnrB13</i>. All 11 <i>qnrB</i>-carrying <i>C. freundii</i> isolates belonged to cluster 1, and one <i>C. freundii</i> isolate carried a new <i>qnrB</i> gene (<i>qnrB92</i>). Six isolates showed strong cytotoxicity to HEp-2 cells, one of which was multidrug resistant. <b>Conclusions:</b><i>C. freundii</i> isolates from human diarrheal outpatients and healthy individuals were diverse with variation in sequence types, antibiotic resistance profiles and virulence properties.