Antimicrobial Susceptibility Pattern and Virulence Genes Detection in Citrobacter freundii Isolated from Patients of a Tertiary Care Hospital, Bangladesh
Antimicrobial susceptibility pattern and virulence genes detection in Citrobacter freundii
Keywords:Antimicrobial resistance, Citrobacter freundii, nosocomial infection, virulence gene.
Citrobacter freundii is an infrequent hospital acquired pathogen to cause different types of disease in clinical settings. This pathogen is associated with wide range of infections causing unpredictably high mortality rate of 30-60%. Separation of this pathogen in health care settings is escalating and multidrug resistant strains are emerging. Therefore, this study aimed to detect antimicrobial resistance pattern and virulence genes among the isolated C. freundii.
A total 500 samples (urine, stool, wound swab & pus, blood endotracheal aspirates and sputum) from patients with clinically suspected infections irrespective of age and sex were used in this study. Disc diffusion method was used to detect susceptibility pattern of antibiotics; colistin, tigecycline and fosfomycin susceptibility pattern was identified by minimum inhibitory concentration (MIC) method. Polymerase chain reaction (PCR) was done to detect potential virulence genes.
Among 27 isolated C. freundii, majority were resistant to amoxiclav (92.59%), trimethoprim-sulfomethoxazole (88.89%), cefotaxime and ceftazidime (85.19%) followed by ceftriaxone (81.48%), cefepime and ciprofloxacin (77.78%). MIC showed least resistance to colistin (29.63%), fosfomycin (11.11%) and tigecycline (7.41%). PCR was positive for via B gene (48.15%) and lt-A gene (25.93%). hly A, lt, lt-h genes showed negative results.
Antibiotic resistance found in this study is quite worrisome as widespread resistance is seen among the bacteria isolated from human infection. Also, virulence genes play important role in C. freundii infection.
Liu X, Huang Y, Xu X, Zhao Y and Sun Q. Complete genome sequence of multidrug-resistant Citrobacter freundii strain P10159, isolated from urine samples from a patient with esophageal carcinoma Genome Announc 2016; 4: e01754-15.
Samonis G, Karageorgopoulos DE, Kofteridis DP, Matthaiou DK, Sidiropoulou V, Maraki S, et al. Citrobacter infections in a general hospital: characteristics and outcomes. Eur J Clin Microbiol Infect Dis 2009; 28:61-68.
Ranjan KP, Ranjan N. Citrobacter: An emerging health care associated urinary pathogen. Urol Ann 2013; 5:313-14
Anjana S, Varsha S, Arunima S. Multiple Antibiotic resistance profile of environmental Citrobacter isolates harboring virulent markers isolated from fresh water reverine environment of Narmada, India. Int J Adv Res 2015; 3:762-70.
Doran TI. The role of Citrobacter in clinical disease of children. Clin Infect Dis 1999; 28:384-94.
Tassew H, Abdissa A, Beyene G, Gebre-Selassie S. Microbial flora and food borne pathogens on minced meat and their susceptibility to antimicrobial agents. Ethiop J Health Sci 2010; 20:137-40
Liu L, Chen D, Liu L, Lan R, Hao S, Jin W, et al. Genetic diversity, multidrug resistance, and virulence of Citrobacter freundii from diarrheal patients and healthy individuals. Front Cell Infect Microbiol 2018; 8:233.
Heo GJ, Hossain S, Wimalasena SH. Virulence factors and antimicrobial resistance pattern of Citrobacter freundii isolated from healthy pet turtles and their environment. Asian J Anim Vet Adv 2016; 221-28.
Lin CL, Chiu CH, Chu C, Huang YC, Lin TY, Ou JT. A multiplex polymerase chain reaction method for rapid identification of Citrobacter freundii and Salmonella species, including Salmonella Typhi. J Microbial Immunol Infect 2007; 40:222-26.
Sobieszczańska BM, Osek J, Gryko R, Dobrowolska M. Association between cell-bound haemolysin and cell-detaching activity of Escherichia coli isolated from children. J Med Microbiol 2006; 55:325-30.
Ferri M, Ranucci E, Romagnoli P, Giaccone V. Antimicrobial resistance: a global emerging threat to public health systems. Crit Rev Food Sci Nutr. 2017; 57:2857-76.
Majewski P, Wieczorek P, Łapuć I, Ojdana D, Sieńko A, Sacha P, et al. Emergence of a multidrug-resistant Citrobacter freundii ST8 harboring an unusual VIM-4 gene cassette in Poland. Int J Infect Dis 2017; 61:70-3.
Nada T, Baba H, Kawamura K, Ohkura T, Torii K, Ohta M. A small outbreak of third generation cephem-resistant Citrobacter freundii infection on a surgical ward. Jpn J Infect Dis 2004; 57:181-2.
Thapa B, Adhikari P, Mahat K, Chhetri MR, Joshi LN. Multidrug-resistant nosocomial Citrobacter in a hospital in Kathmandu. Nepal Med Coll J 2009;11:195-9.
Menon T, Bindu D, Kumar CP, Nalini S, Thirunarayan MA. Comparison of double disc and three dimensional methods to screen for ESBL producers in a tertiary care hospital. Indian J Med Microbiol 2006; 24:117-20.
Mohanty S, Singhal R, Sood S, Dhawan B, Kapil A, Das BK. Citrobacter infections in a tertiary care hospital in Northern India. J Infect 2007; 54:58-64.
Liu LH, Wang NY, Wu AY, Lin CC, Lee CM, Liu CP. Citrobacter freundii bacteremia: Risk factors of mortality and prevalence of resistance genes. J Microbiol Immunol Infect 2018b; 51:565-72.
Sami H, Sultan A, Rizvi M, Khan F, Ahmad S, Shukla I et al. Citrobacter as a uropathogen, its Prevalence and antibiotic susceptibility pattern. J Health Res 2017; 4: 23-26.
Dancer SJ. The problem of cephalosporins. J Antimicrob Chemother 2001; 48: 463-78.
Pepperell C, Kus JV, Gardam MA, Humar A, Burrows LL. Low-virulence Citrobacter species encode resistance to multiple antimicrobials. Antimicrob Agents Chemother 2002; 46:3555-60.
Al-Hissnawy DS, AL-Thahab AA, Al-Jubori SA. Evaluation of Citrobacter freundii isolated in Najaf governorate as an enterotoxin producer. Al-Kufa Univ J Biol 2012;4:1-7.
Bunyan IA. Molecular Study of Some Virulence Factors and Antimicrobial Susceptibility Pattern of Citrobacter frundii Isolated from Human Diarrhea. Sys Rev Pharm 2020; 11:195-201
Copyright (c) 2022 Asma Rahman, S.M. Shamsuzzaman, Nigha Zannat Dola
This work is licensed under a Creative Commons Attribution 4.0 International License.
- Authors retain copyright and grant the journal right of first publication with the work simultaneously licensed under a Creative Commons Attribution License that allows others to share the work with an acknowledgement of the work's authorship and initial publication in this journal.
- Authors are able to enter into separate, additional contractual arrangements for the non-exclusive distribution of the journal's published version of the work (e.g., post it to an institutional repository or publish it in a book), with an acknowledgement of its initial publication in this journal.
- Authors are permitted and encouraged to post their work online (e.g., in institutional repositories or on their website) prior to and during the submission process, as it can lead to productive exchanges, as well as earlier and greater citation of published work (See The Effect of Open Access and Benefits of Publishing Open Access).
This journal provides immediate open access to its content on the principle that making research freely available to the public supports a greater global exchange of knowledge.
Articles are published Under License of Creative Commons Attribution 3.0 License Â©
Copyright policies & self-archiving
This is our Copyright Policy. We are a RoMEO green journal.
|Author's Pre-print:||author can archive pre-print (ie pre-refereeing)|
|Author's Post-print:||author can archive post-print (ie final draft post-refereeing)|
|Publisher's Version/PDF:||author can archive publisher's version/PDF|