Decreased susceptibility to imipenem and ceftazidime in early virulent Raoultella spp. strains retrieved from human intestinal infections

The genus Raoultella spp. is comprised of four species, namely, R. electrica, R. ornithinolytica, R. planticola, and R. terrigena, which are rarely reported to cause infections in humans. This study aimed to characterize six strains of Raoultella spp. isolated from stool samples from patients with diarrhea. The strains included in the study were previously identified by biochemical methods as K. pneumoniae, during a surveillance study conducted in 1987. In the present study, the strains were re-identified by MALDI TOF and 16S rRNA sequencing and subsequently subjected to virulence gene screening by PCR, hemolytic activity, biofilm formation, hypermucoviscosity phenotype, capacity to interact with Caco-2 cells, and antimicrobial susceptibility test. Our results revealed that, among the six strains, three were identified as R. ornithinolytica and three as R. planticola. The genes related to iron uptake systems (aero1, aero2, iutA, entB, and ybtS) and adhesin (mrkD) were found in all strains. Furthermore, all strains demonstrated the ability to interact in vitro with Caco-2 cells and form biofilms. In general, the strains studied were sensitive to the antimicrobials tested; however, it was possible to observe high MICs for imipenem compared to ertapenem and meropenem and high minimal inhibitory concentrations (MICs) for ceftazidime, except for one strain. Our results show the occurrence of virulent strains of Raoultella spp. with high MICs for imipenem and ceftazidime causing diarrhea. We hope that our findings can contribute to the understanding of the evolution of this species since, as far as we know, these are the oldest isolates reported so far.

Automated summary

Highly resistant strains of Raoultella spp. were found in stool samples from patients with diarrhea, capable of biofilm formation and interaction with human cells.