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We examined the prevalence and transmission of the  fosA3  gene among  Citrobacter freundii  isolates from flowers and the retail environments. We identified 11 fosfomycin-resistant  C. freundii  strains (>256 μg/mL) from 270 samples that included petals ( n  = 7), leaves ( n  = 2), dust ( n  = 1) and water ( n  = 1). These 11 isolates were multidrug-resistant and most were simultaneously resistant to fosfomycin, cefotaxime, ciprofloxacin and amikacin. Consistently, all 11 isolates also possessed  bla   CTX–M–   14 ,  bla   CMY–   65  /  122 ,  aac(6’)-Ib-cr ,  qnrS1 ,  qnrB13/6/38  and  rmtB . These  fosA3 -positive isolates were assigned to two distinct PFGE patterns and one ( n  = 9) predominated indicating clonal expansion of  fosA3 -positive isolates across flower markets and shops. Correspondingly,  fosA3  was co-transferred with  bla   CTX–M–   14   via  two plasmid types by conjugation possessing sizes of 110 kb ( n  = 9) and 260 kb ( n  = 2). Two representatives were fully sequenced and p12-1 and pS39-1 possessed one and two unclassified replicons, respectively. These plasmids shared a distinctive and conserved backbone in common with  fosA3 -carrying  C. freundii  and other  Enterobacteriaceae  from human and food animals. However, the  fosA3 - bla   CTX–M–   14 -containing multidrug resistance regions on these untypable plasmids were highly heterogeneous. To the best of our knowledge, this is the first report of  fosA3  and  bla   CTX–M–   14  that were present in bacterial contaminants from flower shops and markets. These findings underscore a public health threat posed by untypable and transferable p12-1-like and pS39-1-like plasmids bearing  fosA3 - bla   CTX–M–   14  that could circulate among  Enterobacteriaceae  species and in particular  C. freundi  in environmental isolates.

Emergence of fosA3 and blaCTX–M–14 in Multidrug-Resistant Citrobacter freundii Isolates From Flowers and the Retail Environment in China