Prevalence, and Microbiological and Clinical Characteristics of Elizabethkingia Isolates from a tertiary hospital in Jiangxi Province, China

Prevalence, and Microbiological and Clinical Characteristics of Elizabethkingia Isolates from a tertiary hospital in Jiangxi Province, China | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Prevalence, and Microbiological and Clinical Characteristics of Elizabethkingia Isolates from a tertiary hospital in Jiangxi Province, China Xiuhua Kang, Huaming Guo, Shanting Zhao, Wenzhen Zhang, Peng Liu, and 4 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-4674119/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 10 You are reading this latest preprint version Abstract Background Elizabethkingia infections have gradually become life-threatening hospital-acquired infections worldwide with increasing morbidity, multidrug resistance, and poor prognosis. However, information on the epidemiological and clinical characteristics of Elizabethkingia infections in mainland China is limited. The aim of this study was to analyze the molecular and clinical characteristics, and drug susceptibility of clinical Elizabethkingia isolates from a hospital in Jiangxi Province, China. Results The mean age of the patients was 61 years (excluding one 13-day-old infant) and 74.8% were male. In total, 85.4% of patients admitted to Intensive Care Unit were infected with Elizabethkingia . COVID-19, respiratory disease, and central venous catheterization rates were significantly different ( P <0.05) between the surviving and dying groups. Sequencing of 103 isolates identified 92 strains of Elizabethkingia anopheles , eight strains of Elizabethkingia meningoseptica, two strains of Elizabethkingia bruuniana , and one strain of Elizabethkingia ursingii. The Vitek MS had a correct identification rate of 87% for E. anopheles . More than 90% of the Elizabethkingia isolates were susceptible to minocycline, but resistant to other drugs, including ceftazidime, aztreonam, and imipenem. Resistance genotype analysis showed that blaBlaB and blaCME were highly prevalent in the Elizabethkingia isolates. Molecular typing revealed 29 different PFGE types with clonal transmission between wards. Conclusions Multidrug-resistant Elizabethkingia are beingdetected at increasing rates; a larger database is required for strain identification of this bacterium. This database could be beneficial for the subsequent determination of optimal antimicrobial drugs for the treatment of infections caused by different Elizabethkingia strains. Our PFGE model showed that most isolates had sufficient genetic diversity and clonal transmission; adequate attention should be paid to this pathogen. Figures Figure 1 Figure 2 Background The genus Elizabethkingia comprises aerobic, oxidase-positive, glucose-unfermenting, nonautotrophic, gram-negative bacilli that are common in soil, freshwater, saltwater, and hospital environments, but rare in humans ( 1 ). Although a rare pathogen, Elizabethkingia meningoseptica , which causes outbreaks of neonatal meningitis, is known to cause life-threatening infections and has been associated with human infections since it was first reported by Elizabeth O. King in 1959 in a neonatal case of meningitis ( 2 , 3 ). Advances in molecular techniques have revealed that several isolates, previously known as E. meningoseptica , belong to different species with new classifications and nomenclature. To date, at least seven species have been classified into the genus Elizabethkingia including E. meningoseptica, Elizabethkingia anopheles ( 4 ), Elizabethkingia miricola ( 5 ), Elizabethkingia argenteiflava ( 6 ), Elizabethkingia occulta, Elizabethkingia ursingii , and Elizabethkingia bruuniana ( 7 ). E. anopheles was isolated from the midgut of a mosquito (Anopheles gambiae) in 2011 ( 6 ). The first human infection with E. anophelis was meningitis in a newborn in the Central African Republic in 2013 ( 8 ). In 2018, three new species were identified: E. occulta, E. ursingii , and E. bruuniana ( 9 ). Environmental studies have shown that Elizabethkingia can survive in water supply systems and often colonizes sinks, basins, and faucets, creating a potential reservoir of infection within hospitals ( 10 ). Elizabethkingia can be introduced to patients through medical equipment contaminated with fluids (e.g., respirators, intubation tubes, fog tents, humidifiers, neonatal incubators, and freezers), and can also be transmitted through wet and dry materials and surfaces, including the hands of hospital staff. Hospital transmission of Elizabethkingia has also been reported in immunocompromised adults in intensive care units (ICUs). Nosocomial outbreaks of Elizabethkingia occur worldwide, especially infections involving ICU patients requiring ventilator support ( 11 , 12 ). Outbreaks have been mainly related to healthcare and, often, water sources ( 13 , 14 ). Evidence suggests that most human infections are caused by E. anopheles ( 15 ). The importance of early detection and treatment has been further reinforced by the increasing number of Elizabethkingia infections worldwide in recent years, with high morbidity and mortality rates ( 16 ). Due to their Ambler class A serine extended-spectrum β-lactamase (ESBL) gene, blaCME , and the Ambler class B metallo-β-lactamase (MBL) genes, blaBlaB and blaGOB , Elizabethkingia species are intrinsically resistant to a wide variety of β-lactams, contributing to their natural resistance to several commonly used carbapenem antibiotics. Elizabethkingia species are also known to be resistance to quinolones, owing to DNA mutations in their rotamase and/or topoisomerase IV genes ( 17 , 18 ). Elizabethkingia has the unique ability to acquire multi-drug resistance and survive disinfectants, therefore spread between patients via human/inanimate host material in hospital environments is a concern. Therefore, it is critical to identify the source of infection and establish the kinetics of its spread within hospital environments ( 2 ). Elizabethkingia -related infections are complicated by biofilm formation, intracellular invasion, and multidrug resistance of strains; the careful selection of appropriate antimicrobial agents is required. Three species, E. meningoseptica, E. miricola , and E. anophelis , cannot be distinguished by their phenotypic characteristics, and are often misidentified by biochemical or other commercial systems because of the limited Elizabethkingia database available. Previous studies have misidentified E. anophelis , E. bruniana , E. ursingii , and E. occulta as E. meningoseptica , suggesting an underestimation of the likelihood of infection with these species ( 18 ). Most studies investigating Elizabethkingia have used unreliable microbial identification methods; therefore, these studies present the clinical or molecular characteristics of all Elizabethkingia species, not each individual species. Despite their clinical significance, gaps remain in our understanding of the demographics, pathogenicity, and effective treatment options of Elizabethkingia infections. In this study, the epidemiology, clinical characteristics, and antibiotic susceptibility of Elizabethkingia isolates collected from a hospital affiliated with Nanchang University in 2022 and 2023 were analyzed using 16S rRNA sequencing. We evaluated the susceptibility of Elizabethkingia isolates to 16 antibiotics and compared the results of 16S rRNA sequencing with those of the VITEK MS assay to identify the strains to evaluate the feasibility of this mass spectrometry. Methods Clinical specimens and identification of Elizabethkingia Isolates Clinical specimens for bacterial culture were collected from at the First Affiliated Hospital of Nanchang University, a tertiary comprehensive hospital in China with 6,100 beds, between January 2022 and December 2023. A total of 103 specimens were collected from 103 hospitalized patients who were isolated from a variety of sources. The species were initially identified using Vitek MS (bioMérieux). The isolates identified as Elizabethkingia spp . were frozen until use. Species Identification Using 16S rRNA Gene Sequencing The 16S rRNA gene was amplified and sequenced using the universal primers 27F: 50- AGAGTTTGATCMTGGCTCAG-30 and 1492R:50-TACGGYTACCTTGTTACGACTT-3'( 18 ). The PCR reaction mixture (50 mL) consisted of 1 uL of each primer, 6 uL of genomic DNA, and 25 uL of 5xPCR Master Mix. PCR was performed with the following conditions: denaturation at 95℃ for 5 minutes; 35 cycles of denaturation at 95℃ for 15 seconds, annealing at 56℃ for 15 seconds, and extension at 72℃ for 15 seconds; and a final extension at 72℃ for 5 minutes. The 1,488 bp product was analyzed via 1% agarose gel electrophoresis and visualized with ethidium bromide staining( 34 ). The assembled 16S rRNA sequences were submitted to the National Center for Biotechnology Information website for comparison with the GenBank sequence database using the Basic Local Alignment Search Tool ( https://blast.ncbi.nlm.nih.gov/Blast.cgi ). The similarity of the 16S rRNA sequences of isolates to the type strains in the GenBank sequence databases was examined using the following reference sequences: E. anophelis strain R26, GenBank accession number NR_116021.1; E. meningoseptica type strain 13253, NR_042267.1; E. bruuniana strain SBRL-21-126, NZ_JAMBNJ010000000; and E. ursingii strain G4122,NZ_LNOK01000023)( 35 ). All clinical isolates were identified by Vitek MS and 16sRNA gene sequencing, and with 16sRNA as the gold standard, we compared the accuracy of Vitek MS in identifying Elizabethkingia isolates ( 21 ). Antimicrobial susceptibility testing In vitro drug susceptibility testing was conducted using the Vitek2-Compact fully automated microbial analysis system. Interpretations of resistance (R), intermediate resistance (I), and sensitivity (S) were performed in accordance with the criteria established by the Clinical Laboratory Standards Institute (M100-S27). PCR amplification was performed to detect the presence of seven resistance genes ( blaBlaB , blaGOB , and blaCME ) as previously described ( 19 ). The amplification primers, systems, and conditions were obtained from the literature. Molecular Typing Pulsed-field gel electrophoresis (PFGE) was utilized to appraise the homology of all strains( 34 ). Genomic DNA of Elizabethkingia was fabricated via digestion with the restriction enzyme XhoI for 4 hours at 37°C. The molecular size marker of strain Braenderup H9812 was processed with XbaI( 11 ). Furthermore, the DNA fragments were segregated by employing the CHEF Mapper XA System (Bio-Rad) at 6V/cm for 18h. PFGE band profiles were analyzed with BioNumerics 8.0. Similarity matrices were computed using Dice's coefficients with 1.5% optimization and 1.5% band matching tolerance. Dendrograms were constructed using the unweighted pair group method with arithmetic averages (UPGMA) ( 36 ). Isolates were categorized into PFGE subtypes (≥ 95% similarity), PFGE types (85–95% similarity), or different types (< 85% similarity) ( 21 ). Statistical Analysis The data were analyzed with SPSS 26.0 statistical software. Categorical data were expressed as frequencies and percentages. Chi-squared or Fisher’s exact tests were used to compare categorical variables (sex, underlying diseases, operation, indwelling device, ICU admission, principal disease, fungal infection, and COVID-19). Continuously quantitative data (age, hospitalization duration, temperature, white blood cell count, hemoglobin, neutrophil percentage, platelet count, lymphocyte count, lymphocyte percentage, proealcitonin, C-reactive protine, and serum creatinine) were expressed as the mean ± standard deviation and compared by T test. A P -value of < 0.05 was considered statistically significant. Results Identification and Prevalence of Elizabethkingia Isolates A total of 103 Elizabethkingia isolates, identified by conventional methods, were collected at a university-affiliated hospital in 2022 and 2023. Among the 103 isolates, the species identified using 16S rRNA gene sequencing were 92 isolates (89.3%) of E. anophelis (99.4–100.0% nucleotide identity to E. anophelis type strain R16), eight isolates (7.3%) of E. meningoseptica (99.5–99.9% nucleotide identity to E. meningoseptica type strain ATCC 13253), two isolates (1.9%) of E. bruuniana , and one isolate (1.0%) of E. ursingii . But we found ambiguity in the identification of E. bruuniana and E. ursingii . A matrix-assisted laser desorption ionization time-of-flight (MALDI-TOF) Vitek MS system with an amended database was used and its feasibility for the identification of Elizabethkingia isolates was evaluated. Using VITEK MS, 80.6% of Elizabethkingia isolates (83 of 103) were correctly identified. VITEK MS identified 80 strains (87.0%) of E. anophelis and correctly identified three strains (37.3%) of E. meningoseptica , demonstrating improved accuracy compared with other methods (Table 1 ). Of these, seven (6.8%) strains of E. anophelis were misidentified as E. miricola , five (4.8%) strains of E. anophelis were misidentified as E. meningoseptica , five (4.8%) strains of E. meningoseptica were misidentified as E. anophelis , and one (1%) strain of E. ursingii was misidentified as E. anophelis . Further, there was one instance each of E. bruuniana being misidentified as E. miricola (1%) and E. bruuniana being misidentified as E. anophelis (1%). These results imply that Vitek MS may be unreliable in identifying E. meningoseptica and E. miricola . Additionally, 16 sputum samples showed concomitant isolates of other bacterial species, such as Acinetobacter baumannii , Acinetobacter SPP, Klebsiella pneumoniae , and Stenotrophomonas maltophilia . Table 1 Comparison of Vitek MS with 16S rRNA gene sequencing in Elizabethkingia isolates identification 16S rRNA sequencing Vitek MS E. anophelis E. meningoseptica E. miricola Correct discrimination False discrimination Correct discrimination False discrimination Correct discrimination False discrimination E. anophelis (n = 92) 80(87.0%) 5(5.4%) 7(7.6%) E. meningoseptica (n = 8) 5(62.5%) 3(37.5%) E. bruuniana (n = 2) 1(50.0%) 1(50.0%) E. ursingii (n = 1) 1(100.0%) Clinical Characteristics of Elizabethkingia Infections Among the 103 Elizabethkingia isolates, including 36 strains collected in 2022 and 67 strains collected in 2023, the most common site of isolation was the respiratory tract (90.3%), followed by the blood (3.9%). Other sites of isolation included the cerebrospinal fluid (1.9%), urine (1.9%), pleural fluid (1%), and catheter tips (1%) (Fig. 1 ). Of these patients, 74.8% were male and 25.2% were female; the average age of the patients was 60 ± 18 years (excluding one 13-day-old patient) (Table 2 ). Prolonged hospital stays (≥ 2 weeks) was observed in 97 patients. Comorbidities were identified in most hospitalized patients, with hypertension being the most prevalent underlying disease (37/103; 35.9%), followed by diabetes mellitus (18/103; 17.5%), and chronic obstructive pulmonary disease (11/103; 10.7%). A large portion of the patients had nervous system disease (59.2%), while 41.4% had cardiovascular disease, and 38.3% had experienced trauma. Furthermore, 88 (85.4%) patients were treated in the ICU, 67 (65.0%) underwent surgery, and 82 (79.6%) received mechanical ventilation. Central venous catheters were placed in 75 patients (72.8%). A total of 36 deaths occurred, corresponding to a mortality rate of 35.0%. Compared to the survivors, the 36 patients who died were significantly older (67 ± 16 vs 57 ± 18 years; P = 0.006), and had significantly more central venous catheters (86.1 vs. 65.7%, respectively; P = 0.026), and Foley’s catheters (88.9 vs. 71.6%; P = Table 2 Factors associated with mortality in patients with Elizabethkingia infections Total(n = 103) Survivors (n = 67) Deaths (n = 36) p-Value Age (Years)(mean ± SD) 60 ± 18 57 ± 18 67 ± 16 0.006 Male, n(%) 77(74.8%) 47(70.1%) 30(83.3%) 0.142 Hospitalization duration(days) (mean ± SD) 43 ± 31 45 ± 35 35 ± 17 0.04 Operation, n(%) 67(65.0%) 49(73.1%) 18(50%) 0.019 Indwelling device, n (%) Mechanical ventilation, n(%) 82(79.6%) 52(77.6%) 30(83.3%) 0.492 Central venous catheter n(%) 75(72.8%) 44(65.7%) 31(86.1%) 0.026 Nasogastric tube n(%) 73(70.9%) 45(67.2%) 28(77.8%) 0.258 Foley’s catheter, n(%) 80(77.7%) 48(71.6%) 32(88.9%) 0.045 Surgical puncture or drain n(%) 47(45.6%) 31(46.3%) 16(44.4) 0.859 ICU admission, n(%) 88(85.4%) 53(79.1%) 35(97.2%) 0.013 COVID-19, n(%) 11(10.7%) 2(3.0%) 9(25%) 0.001 Fungal infection, n(%) 42(40.8%) 23(34.3%) 19(52.8%) 0.069 Underlying diseases, n(%) Diabetes mellitus, n(%) 18(17.5%) 12(17.9%) 6(16.7%) 0.874 Hypertension, n(%) 37(35.9%) 24(35.8%) 13(36.1%) 0.977 Chronic obstructive pulmonary disease, n(%) 11(10.7%) 3(4.5%) 8(22.2%) 0.005 Principle disease, n(%) Nervous system, n(%) 61(59.2%) 36(53.7%) 25(69.4%) 0.122 Malignancy, n(%) 5(4.9%) 4(6.0%) 1(2.8%) 0.472 Trauma, n(%) 40(38.3%) 30(44.8%) 11(30.6%) 0.16 Cardiovascular, n(%) 43(41.4%) 28(41.8%) 15(41.7%) 0.99 Digestive, n(%) 21(20.4%) 17(25.4%) 4(11.1%) 0.087 Respiratory, n(%) 35(34.0%) 17(25.4%) 18(50%) 0.012 Temperature(℃) (mean ± SD) 37.7 ± 0.8 37.6 ± 0.7 37.8 ± 0.9 0.338 Laboratory data White blood cell count (×10^9/L) (mean ± SD) 11.6 ± 7.1 10.9 ± 7.0 13.0 ± 7.1 0.15 Hemoglobin (g/dL) (mean ± SD) 86.7 ± 20.8 87.7 ± 16.0 84.8 ± 27.8 0.496 Platelet count (×10^9/L) (mean ± SD) 226.8 ± 154.0 254.1 ± 146.6 175.8 ± 156.4 0.013 Neutrophil percentage(%)(mean ± SD) 78.4 ± 14.8 77.6 ± 14.4 79.9 ± 15.6 0.455 Lymphocyte count(×10^9/L) (mean ± SD) 1.0 ± 0.6 1.0 ± 0.6 1.1 ± 0.8 0.563 Lymphocyte percentage(%) 11.1 ± 8.5 11.9 ± 9.2 9.4 ± 6.7 0.167 C-reactive protine(mg/L) 66.25 ± 54.3 50.88 ± 38.1 94.4 ± 65.1 0.001 Serum creatinine (mg/dL) (mean ± SD) 106.4 ± 74.2 85.9 ± 55.8 144.5 ± 88.5 0.001 Proealcitonin (ng/mL) (mean ± SD) 2.4 ± 5.1 1.2 ± 3.0 4.4 ± 7.0 0.017 0.045) placed. Furthermore, the distribution of primary diseases showed a significant difference, with a higher percentage of respiratory diseases in patients who died compared to survivors (50.0 vs. 25.4%; P = 0.012); COVID-19 was the most significant risk factor associated with mortality (25 vs. 3%; P = 0.001). Laboratory data showed that C-reactive protein, serum creatinine, and procalcitonin levels were significantly different between the survival and death groups ( P < 0.05); however, white blood cell count, hemoglobin level, neutrophil percentage, lymphocyte count, and lymphocyte percentage showed no significant differences. Table 3 Antimicrobial Susceptibilities of 103 Elizabethkingia Isolates Determined by the Vitek2-Compact fully automated microbial analysis system No. of isolates with result/total no. of isolates tested (%) E.Anophelis E.Meningoseptic E.Bruuniana E.Ursingii Total isolates antimicrobial agents S I R S I R S I R S I R S I R Piperacillin-tazobactam 26/90(28.9) 3/90(3.3) 61/90(67.8) 6/8(75) 0 2/8( 25 ) 0 1/2(50) 1/2(50) 0 0 1/1(100) 32/1(31.7) 4/101 (4.0) 65/101 (63.3) Ticarcillin-clavulanic acid 2/55(3.6) 6/55(10.9) 47/55(85.5) 0 0 2/2(100) 0 0 1/1(100) 0 0 1/1(100) 2/59(3.4) 6/59(10.2) 51/59(86.4) Ceftazidime 0 1/68(1.5) 67/68(98.5) 0 0 2/2(100) 0 0 2/2(100) 0 0 1/1(100) 0 1/73(1.4) 72/73(98.6) Cefepime 0 5/91(5.5) 86/91(94.5) 0 0 8/8(100) 0 0 2/2(100) 0 0 1/1(100) 0 5/102(4.9) 97/102(95.1) Cefoperazone-sulbactam 2 (12.5) 2/16 (12.5) 12/16 (75) 0 0 1/1(100) 0 0 1/1(100) 0 0 0 2/18(11.1) 2/18(11.1) 14/18(77.8) Aztreonam 0 0 91/91 (100) 0 0 8/8(100) 0 0 2/2(100) 0 0 1/1(100) 0 0 102/102(100) Imipenem 2/92 (2.2) 0 90/92 (97.8) 0 0 8/8(100) 0 0 2/2(100) 0 0 1/1(100) 2/103(1.9) 0 101/103(98.1) Meropenem 0 2/62 (3.2) 60/62 (96.8) 0 0 2/2(100) 0 0 1/1(100) 0 0 1/1(100) 0 2/66(3.0) 64/66(97.0) Amikacin 3/92 (3.3) 1/92 (1.1) 88/92 (95.6) 0 0 8/8(100) 1/2 0 1/2 (50) 0 0 1/1(100) 4/103 (3.9) 1/103 (1.0) 98/103 (95.1) Ciprofloxacin 21/92 (22.8) 3/92 (3.3) 68/92 (73.9) 1/8 (12.5) 0 7/8 (87.5) 2/2(100) 0 0 0 0 1/1(100) 24/103 (23.3) 3/103 (2.9) 76/103 (73.8) Levofloxacin 30/92 (32.6) 0 62/92 (67.4) 1/8 (12.5) 0 7/8 (87.5) 1/2 (50) 0 1/2 (50) 0 0 1/1(100) 32/103 (31.1) 0 71/103 (68.9) Trimethoprim-sulfamethoxazole 71/89 (79.8) 0 18/89 (20.2) 8/8(100) 0 0 1/2 (50) 0 1/2 (50) 1/1(100) 0 0 81/100 (81) 0 19/100 ( 19 ) Doxycycline 54/61 (88.5) 1/61 (1.6) 6/61 (9.9) 2/2(100) 0 0 1/1(100) 0 0 1/1(100) 0 0 58/65 (89.3) 1/65 (1.5) 6/65 (9.2) Minocycline 59/61 (96.7) 0 2/61 (3.3) 2/2(100) 0 0 1/1(100) 0 0 1/1(100) 0 0 63/65 (96.9) 0 2/65 (3.1) Gentamicin 1/31 (3.2) 4/31 (12.9) 26/31 (83.9) 0 0 6/6(100) 0 0 1/1(100) 0 0 0 1/38 (2.6) 4/38 (10.5) 33/38 (86.9) Tobramycin 3/92 (3.3) 0 89/92 (96.7) 0 0 8/8(100) 1/2 (50) 0 1/2 (50) 0 0 1/1(100) 4/103 (3.9) 0 99/103 (96.1) Antimicrobial susceptibilities and Genotype of Elizabethkingia Isolates The drug susceptibilities of the 103 Elizabethkingia isolates were determined using the Vitek2-Compact fully automated microbial analysis system (Table 3 ). All isolates were resistant to aztreonam. All 103 isolates were susceptible to at least one antimicrobial agent tested. Sixty-three of 65 isolates (96.9%) tested were susceptible to minocycline, 58/65 (89.3%) were susceptible to doxycycline, and 81/100 (81.0%) were susceptible to trimethoprim-sulfamethoxazole. Over 95% of the tested isolates were resistant to ceftazidime, imipenem, meropenem, amikacin and tobramycin. In addition, one E. anophelis isolate was resistant to all antibiotics tested; however, most Elizabethkingia isolates were only sensitive to two or three antibiotics tested (Table 4 ). A total of 69 Elizabethkingia strains carried β-lactamase genes. Of these, 68 Elizabethkingia isolates carried blaBlaB and seven carried blaCME ; none carried blaGOB . Six Elizabethkingia isolates harbored both blaBlaB and blaCME genes (Fig. 2 ). Accordingly, strains carrying these resistance genes were found to be resistant to ceftazidime, cefepime, meropenem, and imipenem, with resistance rates > 90%; this effect was particularly pronounced in E. anophelis and E. meningoseptica . Strains with GryA , GyrB , ParC , and ParE genes were resistant to fluoroquinolones, with approximately 30% susceptibility to ciprofloxacin, which was higher in strains carrying the RND gene for the efflux pump. Table 4 The number of susceptible antibiotics of 103 isolates of Elizabethkingia isolates Number of Susceptible Antibiotics All Isolates (n = 103) Number of Episodes (%) E.Anophelis (92) E.Meningoseptic ( 8 ) E.Bruuniana ( 2 ) E.Ursingii ( 1 ) 0 1(1%) 1(1.1%) 0 0 0 1 5(4.8%) 5(5.4%) 0 0 0 2 29(28.2%) 24(26.1%) 5(62.5%) 0 0 3 42(40.8%) 38(41.3%) 2(25%) 1(50%) 1(100%) 4 17(16.5%) 15(16.3%) 1(12.5%) 1(50%) 0 5 6(5.8%) 6(6.5%) 0 0 0 6 2(1.9%) 2(2.2%) 0 0 0 8 1(1%) 1(1.1%) 0 0 0 Molecular typing of Elizabethkingia Isolates Nineteen Elizabethkingia isolates were found to be resistant to XhoI digestion. The remaining 84 isolates clustered into 29 different pulsed-field gel electrophoresis (PFGE) types (Fig. 2 ). In particular, 74 E. anophelis isolates were divided into 22 clusters designated A–V, seven E. meningoseptica isolates were divided into five clusters designated A–E, and two E. bruuniana and one E. ursingii isolate were divided into two clusters designated A and B. PFGE typing was most common for the J-type with 42 strains, 14 of which belonged to the same subtype. Of these 14 strains, all were from patients admitted to the ICU of the same department within a three month span from which clonal strains of the same subtype were collected (most from sputum) indicating the presence of clonal transmission in the ICU. Most patients with the same subtype experienced cerebrovascular accidents, and received mechanical ventilation and indwelling tubes during hospitalization. Similar antimicrobial susceptibility patterns were observed for different subtypes of the same clustered strains. Discussion Elizabethkingia isolates cause serious nosocomial infections and outbreaks worldwide, but have received relatively little attention. In this study, we used 16S rRNA gene sequencing as a reference method for the species identification of Elizabethkingia spp . collected over two years and analyzed the characteristics of Elizabethkingia spp . obtained from clinical samples. We found that E. anophelis , but not E. meningoseptica , accounted for the majority of human infections with the genus Elizabethkingia, and that the isolation rate of Elizabethkingia almost doubled from 36 strains collected in 2022 to 67 strains in 2023, with increasing detection of E. anophelis . In fact, evidence suggests that E. anopheles, rather than E. meningoseptica, dominates Elizabethkingia in clinical settings (19). Therefore, we must focus on nosocomial Elizabethkingia infections. Advances in microbial identification techniques have made it possible to identify several emerging unusual bacteria that cause disease, primarily in immunocompromised patients. Traditional identification systems are poor at identifying rare species and can easily lead to misidentification, misdiagnosis, treatment failure, and underestimation of the incidence of infection (20). MALDI-TOF, Vitek mass spectrometry (VMS), and molecular identification techniques (16S rRNA, rpoB gene sequencing, and whole genome sequencing) have become useful tools for accurate identification of microorganisms (17, 21). These tools have an excellent discrimination ability, especially for rare opportunistic bacteria. In this study, we found ambiguity in the identification of Ebr97, Ebr131, and Eur74 by 16S rRNA gene sequencing, which may have been due to the presence of multiple copies of the different sequences, as well as the fact these are highly variable regions of 16S rRNA (16). PFGE mapping showed better resolution of clonal relationships, indicating that Ebr131 is more closely related to Ebr97, with a similarity of 85.7%. The rpoB gene is a single-copy gene with a higher phylogenetic evolutionary resolution than the 16S rRNA genes, thus allows for accurate differentiation of Elizabethkingia at the species level (9, 17). Studies have shown that most patients with Elizabethkingia infections have underlying chronic diseases such as diabetes, cardiovascular diseases, and pulmonary diseases (22, 23). Our study yielded similar results. Previous studies have shown that E. meningoseptica is commonly isolated from ICUs in India (24, 25) and Taiwan (26). In the present study, the emergency ICU, trauma ICU, and general ICU were ranked in the top three Elizabethkingia sources. These data consistently suggest that Elizabethkingia favors infection in immunocompromised patients. In patients infected with Elizabethkingia , the mortality rate ranges from 20 to 40% (27). The major risk factors for patients with Elizabethkingia infection include ICU admission, surgery, and the use of an indwelling device. Other risk factors include COVID-19, prolonged hospitalization, and underlying diseases (28). In this study, COVID-19, respiratory illness, mechanical ventilation, and central venous cannulation were risk factors for mortality in patients with Elizabethkingia infection. Elizabethkingia can form biofilms in wet environments or on water-related equipment, facilitating its spread in hospital environments (28, 29). Elizabethkingia was identified in the ward during environmental surveillance sampling; a retrospective review of clinical data revealed that Elizabethkingia had also been identified in the sputum of patients admitted to the ward in the previous ten days, leading to the hypothesis that transmission of this bacterium may occur between caregivers and patients, and that environmental surfaces and shared medical equipment may also place patients at risk of Elizabethkingia infection (30). Elizabethkingia infections are challenging because they tend to exhibit inherent resistance to antimicrobial agents (including beta-lactams and inhibitors, aminoglycosides, macrolides, tetracycline, vancomycin, and carbapenems) (16). Genomic and proteomic analyses have confirmed the presence of multidrug resistance genes and drug efflux systems in Elizabethkingia (31, 32). These strains showed differential susceptibilities to doxycycline, ceftazidime, imipenem, meropenem, amikacin, and tobramycin. The high prevalence of blaBlaB and blaCME genes in the present study is consistent with broad-spectrum resistance to beta-lactams, including carbapenems. Several genes associated with drug resistance have been identified in Elizabethkingia . MBL genes are of global concern as they can confer resistance to carbapenems and almost all β-lactams (33). Elizabethkingia is the only organism known to carry two distinct MBL genes ( blaBlaB and blaGOB ) and the blaCME gene, which can confer resistance to cephalosporins (21). Resistance genes, including gyrA, gyrB, parC, and parE , and efflux pump genes, including RND, MFS, MATE, and ABC , were detected in Elizabethkingia isolates. The presence of multiple drug resistance genes in Elizabethkingia increases the difficulty of clinical treatment (27). PFGE typing reveals genetic diversity and clonal transmission. Although E. anophelis is genotypically highly diverse, clonal transmission has been observed in several pairs of patients from the same or different departments. From April to August in 2022, E. meningoseptica isolates were genetically homogeneous (2/7 strains were type A and 2/7 strains were type B) in the hematology and emergency ICU wards, suggesting recent clonal amplification and persistence between the wards. Previous reports have found that the acquisition of Elizabethkingia may be associated with water sources or water-related equipment, such as sinks and hand hygiene sink aerators in the hospital environment (11, 29). Clonal transmission may be mediated by the hands of hospital staff or patients; therefore, there is a need for better hand hygiene and environmental cleanliness if an isolate is detected in hospitals (15). It should be noted that this study has several limitations. (i) This is a single-center study with some bias in the data, and follow-up studies with larger and more extensive multicenter are needed. (ii) We have not made any further distinction between Elizabethkingia isolates by sequencing the 32rpoB gene and by sequencing the whole genome. (iii) No further exploration of biofilm formation was performed . Conclusions Elizabethkingia infection has become an important public health concern; therefore, it is crucial to understand its clinical, molecular, and genetic characteristics. In the present study, 16S rRNA gene sequencing was performed on 103 Elizabethkingia isolates. Microbiological characterization of the identified Elizabethkingia isolates revealed the resistance patterns and genetic diversity of the clinical isolates at this site. As much research and clinical practice continue to rely on automated bacteriological identification systems to characterize Elizabethkingia , upgrading MALDI-TOF mass spectrometry with expanded reference databases, or the use of molecular techniques, is necessary to accurately characterize these microorganisms. Elizabethkingia exhibits variable susceptibility to various antibiotics; therefore, if antimicrobial susceptibility testing is used as a guide, treatment will be more reliable. Our results show that minocycline has the potential to become the drug of choice for patients with Elizabethkingia infections; however, clinical trials are required. Further research is required to determine the optimal antimicrobial agents for these life-threatening infections, either alone or in combination. Declarations Data availability All data generated or analyzed during this study are included in this published article and raw data will be available upon request. The sequences of detected genes were submitted to the GenBank database under accession numbers PQ057235-PQ057337 Acknowledgements The authors thank all the members in the laboratory. Funding This research was funded by the National Natural Science Foundation of China (grant number 82102411, 82260403,32370195); the Clinical Research Nurture Project of the First Affiliated Hospital of Nanchang University (grant number YFYLCYJPY202201); Science and Technology Program Project of the Health and Wellness Commission of Jiangxi Province(grant number 202130167). Author information Xiuhua Kang and Huaming Guo contributed equally. Authors and Affiliations a Jiangxi Medical Center for Critical Public Health Events, The First Affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang 330052, China. b Infection Control Division, the First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi 330006, P. R. China. c. First Clinical Medical College, Nanchang University, Nanchang, China. d Department of Clinical Laboratory, The First Affiliated Hospital, Jiangxi Medical College, Nanchang University, 17 Yongwai Zhengjie, Nanchang 330006, China e China-Japan Friendship Jiang Xi Hospital, National Regional Center for Respiratory Medicine, Nanchang 330006, Jiangxi, China Contributions The study was designed by DDW and YL, while HMG, STZ , PL, YFM and WZZ conducted the experiments. YL, HMG, LZ and XHK carried out the analysis, and HMG , XHK and DDW drafted the manuscript. All authors contributed to and approved the final version of the article . Corresponding author Correspondence to Yang Liu or Dandan Wei Ethics declarations Ethics approval and consent to participate Based on the rules of the Ethical Committee of our institute, this study did not require informed consent statement, because all isolates were recovered from clinical specimens during routine diagnostic procedures and these isolates were not specific to this study. In addition, the patients were not available to us. Based on the points mentioned above, the Ethics Committee of the First Affiliated Hospital of Nanchang University approved our project and allowed this study to be conducted without informed consent statement. Consent for publication Not applicable. Competing interests The authors declare that they have no competing interest. References Comba IY, Schuetz AN, Misra A, Friedman DZP, Stevens R, Patel R, et al. Antimicrobial Susceptibility of Elizabethkingia Species: Report from a Reference Laboratory. Journal of Clinical Microbiology. 2022;60(6):e0254121. Lin J-N, Lai C-H, Yang C-H, Huang Y-H. Elizabethkingia Infections in Humans: From Genomics to Clinics. Microorganisms. 2019;7(9):295. King EO. Studies on a group of previously unclassified bacteria associated with meningitis in infants. Am J Clin Pathol. 1959;31(3):241-7. Doijad S, Ghosh H, Glaeser S, Kämpfer P, Chakraborty T. Taxonomic reassessment of the genus Elizabethkingia using whole-genome sequencing: Elizabethkingia endophytica Kämpfer et al. 2015 is a later subjective synonym of Elizabethkingia anophelis Kämpfer et al. 2011. Int J Syst Evol Microbiol. 2016;66(11):4555-9. Li Y, Kawamura Y, Fujiwara N, Naka T, Liu H, Huang X, et al. Chryseobacterium miricola sp. nov., a novel species isolated from condensation water of space station Mir. Syst Appl Microbiol. 2003;26(4):523-8. Kämpfer P, Matthews H, Glaeser SP, Martin K, Lodders N, Faye I. Elizabethkingia anophelis sp. nov., isolated from the midgut of the mosquito Anopheles gambiae. Int J Syst Evol Microbiol. 2011;61(Pt 11):2670-5. Lin IF, Lai CH, Lin SY, Lee CC, Lee NY, Liu PY, et al. In Vitro and In Vivo Antimicrobial Activities of Vancomycin and Rifampin against Elizabethkingia anophelis. Int J Mol Sci. 2023;24(23). Teo J, Tan SY, Tay M, Ding Y, Kjelleberg S, Givskov M, et al. First case of E anophelis outbreak in an intensive-care unit. Lancet. 2013;382(9895):855-6. Nicholson AC, Gulvik CA, Whitney AM, Humrighouse BW, Graziano J, Emery B, et al. Revisiting the taxonomy of the genus Elizabethkingia using whole-genome sequencing, optical mapping, and MALDI-TOF, along with proposal of three novel Elizabethkingia species: Elizabethkingia bruuniana sp. nov., Elizabethkingia ursingii sp. nov., and Elizabethkingia occulta sp. nov. Antonie Van Leeuwenhoek. 2018;111(1):55-72. Hoque SN, Graham J, Kaufmann ME, Tabaqchali S. Chryseobacterium (Flavobacterium) meningosepticum outbreak associated with colonization of water taps in a neonatal intensive care unit. J Hosp Infect. 2001;47(3):188-92. Lee YL, Liu KM, Chang HL, Lin JS, Kung FY, Ho CM, et al. A dominant strain of Elizabethkingia anophelis emerged from a hospital water system to cause a three-year outbreak in a respiratory care center. J Hosp Infect. 2021;108:43-51. Ceyhan M, Yildirim I, Tekeli A, Yurdakok M, Us E, Altun B, et al. A Chryseobacterium meningosepticum outbreak observed in 3 clusters involving both neonatal and non-neonatal pediatric patients. Am J Infect Control. 2008;36(6):453-7. Johnson WL, Gupta SK, Maharjan S, Morgenstein RM, Nicholson AC, McQuiston JR, et al. A Genetic Locus in Elizabethkingia anophelis Associated with Elevated Vancomycin Resistance and Multiple Antibiotic Reduced Susceptibility. Antibiotics (Basel). 2024;13(1). Kyritsi MA, Mouchtouri VA, Pournaras S, Hadjichristodoulou C. First reported isolation of an emerging opportunistic pathogen (Elizabethkingia anophelis) from hospital water systems in Greece. J Water Health. 2018;16(1):164-70. Chew KL, Cheng B, Lin RTP, Teo JWP. Elizabethkingia anophelis Is the Dominant Elizabethkingia Species Found in Blood Cultures in Singapore. J Clin Microbiol. 2018;56(3). Lin JN, Lai CH, Yang CH, Huang YH. Elizabethkingia Infections in Humans: From Genomics to Clinics. Microorganisms. 2019;7(9). Wu C, Xiong L, Liao Q, Zhang W, Xiao Y, Xie Y. Clinical manifestations, antimicrobial resistance and genomic feature analysis of multidrug-resistant Elizabethkingia strains. Ann Clin Microbiol Antimicrob. 2024;23(1):32. Puah SM, Fong SP, Kee BP, Puthucheary SD, Chua KH. Molecular identification and biofilm-forming ability of Elizabethkingia species. Microb Pathog. 2022;162:105345. Han MS, Kim H, Lee Y, Kim M, Ku NS, Choi JY, et al. Relative Prevalence and Antimicrobial Susceptibility of Clinical Isolates of Elizabethkingia Species Based on 16S rRNA Gene Sequencing. J Clin Microbiol. 2017;55(1):274-80. Dziuban EJ, Franks JL, So M, Peacock G, Blaney DD. Elizabethkingia in Children: A Comprehensive Review of Symptomatic Cases Reported From 1944 to 2017. Clin Infect Dis. 2018;67(1):144-9. Wang L, Zhang X, Li D, Hu F, Wang M, Guo Q, et al. Molecular Characteristics and Antimicrobial Susceptibility Profiles of Elizabethkingia Clinical Isolates in Shanghai, China. Infect Drug Resist. 2020;13:247-56. Lau SK, Chow WN, Foo CH, Curreem SO, Lo GC, Teng JL, et al. Elizabethkingia anophelis bacteremia is associated with clinically significant infections and high mortality. Sci Rep. 2016;6:26045. Reed TAN, Watson G, Kheng C, Tan P, Roberts T, Ling CL, et al. Elizabethkingia anophelis Infection in Infants, Cambodia, 2012-2018. Emerg Infect Dis. 2020;26(2):320-2. Sarathi S, Behera B, Mahapatra A, Mohapatra S, Jena J, Nayak S. Microbiological Characterization and Clinical Facets of Elizabethkingia Bloodstream Infections in a Tertiary Care Hospital of Eastern India. Infect Drug Resist. 2023;16:3257-67. Ko HK, Yu WK, Lien TC, Wang JH, Slutsky AS, Zhang H, et al. Intensive care unit-acquired bacteremia in mechanically ventilated patients: clinical features and outcomes. PLoS One. 2013;8(12):e83298. Huang YC, Huang YW, Lin YT, Wang FD, Chan YJ, Yang TC. Risk factors and outcome of levofloxacin-resistant Elizabethkingia meningoseptica bacteraemia in adult patients in Taiwan. Eur J Clin Microbiol Infect Dis. 2017;36(8):1373-80. Burnard D, Gore L, Henderson A, Ranasinghe A, Bergh H, Cottrell K, et al. Comparative Genomics and Antimicrobial Resistance Profiling of Elizabethkingia Isolates Reveal Nosocomial Transmission and In Vitro Susceptibility to Fluoroquinolones, Tetracyclines, and Trimethoprim-Sulfamethoxazole. J Clin Microbiol. 2020;58(9). Seong H, Kim JH, Kim JH, Lee WJ, Ahn JY, M DN, et al. Risk Factors for Mortality in Patients with Elizabethkingia Infection and the Clinical Impact of the Antimicrobial Susceptibility Patterns of Elizabethkingia Species. J Clin Med. 2020;9(5). Choi MH, Kim M, Jeong SJ, Choi JY, Lee IY, Yong TS, et al. Risk Factors for Elizabethkingia Acquisition and Clinical Characteristics of Patients, South Korea. Emerg Infect Dis. 2019;25(1):42-51. Jiang X, Wang D, Wang Y, Yan H, Shi L, Zhou L. Occurrence of antimicrobial resistance genes sul and dfrA12 in hospital environmental isolates of Elizabethkingia meningoseptica. World J Microbiol Biotechnol. 2012;28(11):3097-102. Spengler G, Kincses A, Gajdács M, Amaral L. New Roads Leading to Old Destinations: Efflux Pumps as Targets to Reverse Multidrug Resistance in Bacteria. Molecules. 2017;22(3). Agrawal A, Ravikumar R, Varun CN, Kumar M, Chatterjee O, Advani J, et al. Global Proteome Profiling Reveals Drug-Resistant Traits in Elizabethkingia meningoseptica: An Opportunistic Nosocomial Pathogen. Omics. 2019;23(6):318-26. Chang TY, Chen HY, Chou YC, Cheng YH, Sun JR. In vitro activities of imipenem, vancomycin, and rifampicin against clinical Elizabethkingia species producing BlaB and GOB metallo-beta-lactamases. Eur J Clin Microbiol Infect Dis. 2019;38(11):2045-52. Chang YC, Lo HH, Hsieh HY, Chang SM. Identification and epidemiological relatedness of clinical Elizabethkingia meningoseptica isolates from central Taiwan. J Microbiol Immunol Infect. 2014;47(4):318-23. Lin JN, Lai CH, Yang CH, Huang YH. Correction: Jiun-Nong Lin; Chung-Hsu Lai; Chih-Hui Yang and Yi-Han Huang. Comparison of Clinical Manifestations, Antimicrobial Susceptibility Patterns, and Mutations of Fluoroquinolone Target Genes between Elizabethkingia meningoseptica and Elizabethkingia anophelis Isolated in Taiwan. Journal of Clinical Medicine 2018, 7, 538. J Clin Med. 2019;8(4). Cheng J, Zhao D, Ma X, Li J. Molecular epidemiology, risk factors, and outcomes of carbapenem-resistant Klebsiella pneumoniae infection in a tertiary hospital in eastern China: for a retrospective study conducted over 4 years. Frontiers in Microbiology. 2023;14. Additional Declarations No competing interests reported. Supplementary Files DATE1.xlsx 2140276467.zip Cite Share Download PDF Status: Under Review Version 1 posted Editorial decision: Revision requested 17 Sep, 2024 Reviews received at journal 13 Sep, 2024 Reviewers agreed at journal 13 Sep, 2024 Reviews received at journal 10 Aug, 2024 Reviewers agreed at journal 05 Aug, 2024 Reviewers invited by journal 05 Aug, 2024 Editor invited by journal 31 Jul, 2024 Editor assigned by journal 30 Jul, 2024 Submission checks completed at journal 30 Jul, 2024 First submitted to journal 02 Jul, 2024 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-4674119","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":344498062,"identity":"06fc0cf7-e7aa-4ef3-82ce-24b7f73a0b4d","order_by":0,"name":"Xiuhua Kang","email":"","orcid":"","institution":"Jiangxi Medical Center for Critical Public Health Events, The First Affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang 330052, China","correspondingAuthor":false,"prefix":"","firstName":"Xiuhua","middleName":"","lastName":"Kang","suffix":""},{"id":344498064,"identity":"d64b736e-ee35-4b8f-8765-c543d377ec10","order_by":1,"name":"Huaming Guo","email":"","orcid":"","institution":"First Clinical Medical College, Nanchang University, Nanchang, China","correspondingAuthor":false,"prefix":"","firstName":"Huaming","middleName":"","lastName":"Guo","suffix":""},{"id":344498066,"identity":"76fe7d98-304a-4e15-8c14-5b377889bccb","order_by":2,"name":"Shanting Zhao","email":"","orcid":"","institution":"First Clinical Medical College, Nanchang University, Nanchang, China","correspondingAuthor":false,"prefix":"","firstName":"Shanting","middleName":"","lastName":"Zhao","suffix":""},{"id":344498068,"identity":"a5e6242a-ffa1-47f5-af4e-88d05f2ab48d","order_by":3,"name":"Wenzhen Zhang","email":"","orcid":"","institution":"First Clinical Medical College, Nanchang University, Nanchang, China","correspondingAuthor":false,"prefix":"","firstName":"Wenzhen","middleName":"","lastName":"Zhang","suffix":""},{"id":344498069,"identity":"130eba2a-3e1b-4a1c-97e6-fe11b04f3eda","order_by":4,"name":"Peng Liu","email":"","orcid":"","institution":"Department of Clinical Laboratory, The First Affiliated Hospital, Jiangxi Medical College, Nanchang University, 17 Yongwai Zhengjie, Nanchang 330006, China","correspondingAuthor":false,"prefix":"","firstName":"Peng","middleName":"","lastName":"Liu","suffix":""},{"id":344498070,"identity":"d1011b75-bc51-428c-9b55-c7873ae77d67","order_by":5,"name":"Yanfang Mei","email":"","orcid":"","institution":"Department of Clinical Laboratory, The First Affiliated Hospital, Jiangxi Medical College, Nanchang University, 17 Yongwai Zhengjie, Nanchang 330006, China","correspondingAuthor":false,"prefix":"","firstName":"Yanfang","middleName":"","lastName":"Mei","suffix":""},{"id":344498072,"identity":"dd84a71c-1e32-4569-83f5-9ad676ee39db","order_by":6,"name":"Ling Zeng","email":"","orcid":"","institution":"Infection Control Division, the First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi 330006, P. 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China","correspondingAuthor":false,"prefix":"","firstName":"Ling","middleName":"","lastName":"Zeng","suffix":""},{"id":344498074,"identity":"8200aa05-ae64-4f51-bab4-38e97e3ab4cb","order_by":7,"name":"Yang Liu","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA+0lEQVRIie2RsWrDMBCGzwjs5ZJ0lCAPcaVDGijkVWQMyRLo6kIxKg7ukgdooPQxTEcZQydB1nZz8AvEW4eWVpkLUsYO+kbpPn7dL4BA4B8yhqjsv/IfnDBYffIc0KvEwCpCw6biUXX82pylJIqPNuyGtk3H76ozHhbzVJFQMRLPJH28FNNZoqPjsHYr3eUr4owvZbqrW5xvJRO72pOSGo7zp7VsRa2RtIzZyKPwxjZA77dD+f1cIO07vyIeKolkdAZCMev6UvBQXYHRaEteAn9rrXIonbtMklXfQ64X9iutcl8saJ81x8GhwIX8cxQpx/wpRrvvA4FAIAC/xh1R90LrOBEAAAAASUVORK5CYII=","orcid":"","institution":"Jiangxi Medical Center for Critical Public Health Events, The First Affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang 330052, China","correspondingAuthor":true,"prefix":"","firstName":"Yang","middleName":"","lastName":"Liu","suffix":""},{"id":344498075,"identity":"cb10fdc6-1688-439e-a0f3-ee2f7c892aa4","order_by":8,"name":"Dandan Wei","email":"","orcid":"","institution":"Jiangxi Medical Center for Critical Public Health Events, The First Affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang 330052, China","correspondingAuthor":false,"prefix":"","firstName":"Dandan","middleName":"","lastName":"Wei","suffix":""}],"badges":[],"createdAt":"2024-07-02 12:14:13","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-4674119/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-4674119/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":63833034,"identity":"dc6ba182-d194-4b68-b23c-ce97c822a201","added_by":"auto","created_at":"2024-09-02 19:25:12","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":25097,"visible":true,"origin":"","legend":"\u003cp\u003eSource of detection of 103 isolates of \u003cem\u003eElizabethkingia \u003c/em\u003eisolates\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-4674119/v1/b43a0bc88c0e01b88b09f23d.png"},{"id":63833037,"identity":"c1f3d78e-9547-41c4-904a-20da0c437beb","added_by":"auto","created_at":"2024-09-02 19:25:12","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":509829,"visible":true,"origin":"","legend":"\u003cp\u003eDendrogram of PFGE patterns of 84 \u003cem\u003eElizabethkingia\u003c/em\u003eisolates using the BioNumerics software. (A) Seventy-four \u003cem\u003eE. anophelis\u003c/em\u003eisolates; (B) Seven \u003cem\u003eE. meningoseptica\u003c/em\u003e\u003cstrong\u003e \u003c/strong\u003eisolates; (C) Two \u003cem\u003eE. bruuniana \u003c/em\u003eand One \u003cem\u003eE. ursingii\u003c/em\u003e isolates.\u003c/p\u003e\n\u003cp\u003eAbbreviations: M, male; F, female; CAZ, Ceftazidime; CPE, Cefepime; IPM, Imipenem;\u003c/p\u003e\n\u003cp\u003eAMK, Amikacin; \u0026nbsp;\u0026nbsp;CIP ,Ciprofloxacin; DOX, Doxycycline; PTZ, Piperacillin tazobactam; ATM, Aztreonam; \u0026nbsp;\u0026nbsp;TOB, Tobramycin;LVX, Levofloxacin;\u003cstrong\u003e \u003c/strong\u003eMIN, Minocycline; SXT,\u003c/p\u003e\n\u003cp\u003eSulfamethoxazole; S, susceptible; I, intermediate; R, \u0026nbsp;\u0026nbsp;resistant.\u003c/p\u003e","description":"","filename":"2.png","url":"https://assets-eu.researchsquare.com/files/rs-4674119/v1/47026975dcbd34e7fb935612.png"},{"id":63833557,"identity":"840707e9-2e8f-4edc-a6ff-564f886eb0a7","added_by":"auto","created_at":"2024-09-02 19:33:13","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1627021,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-4674119/v1/a5034238-731b-42bc-a52d-862d3459e358.pdf"},{"id":63833036,"identity":"bb91664a-4085-403e-b184-e38e0b704d05","added_by":"auto","created_at":"2024-09-02 19:25:12","extension":"xlsx","order_by":1,"title":"","display":"","copyAsset":false,"role":"supplement","size":38458,"visible":true,"origin":"","legend":"","description":"","filename":"DATE1.xlsx","url":"https://assets-eu.researchsquare.com/files/rs-4674119/v1/6feecde7bb867dcbe92cb00a.xlsx"},{"id":63833035,"identity":"d75eee25-545f-4ab7-9ee2-33a0dead8faa","added_by":"auto","created_at":"2024-09-02 19:25:12","extension":"zip","order_by":2,"title":"","display":"","copyAsset":false,"role":"supplement","size":70113,"visible":true,"origin":"","legend":"","description":"","filename":"2140276467.zip","url":"https://assets-eu.researchsquare.com/files/rs-4674119/v1/bf6c681f20bdbce31ab0998f.zip"}],"financialInterests":"No competing interests reported.","formattedTitle":"Prevalence, and Microbiological and Clinical Characteristics of Elizabethkingia Isolates from a tertiary hospital in Jiangxi Province, China","fulltext":[{"header":"Background","content":"\u003cp\u003eThe genus \u003cem\u003eElizabethkingia\u003c/em\u003e comprises aerobic, oxidase-positive, glucose-unfermenting, nonautotrophic, gram-negative bacilli that are common in soil, freshwater, saltwater, and hospital environments, but rare in humans (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e). Although a rare pathogen, \u003cem\u003eElizabethkingia meningoseptica\u003c/em\u003e, which causes outbreaks of neonatal meningitis, is known to cause life-threatening infections and has been associated with human infections since it was first reported by Elizabeth O. King in 1959 in a neonatal case of meningitis (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e). Advances in molecular techniques have revealed that several isolates, previously known as \u003cem\u003eE. meningoseptica\u003c/em\u003e, belong to different species with new classifications and nomenclature. To date, at least seven species have been classified into the genus \u003cem\u003eElizabethkingia\u003c/em\u003e including \u003cem\u003eE. meningoseptica, Elizabethkingia anopheles\u003c/em\u003e (\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e), \u003cem\u003eElizabethkingia miricola\u003c/em\u003e (\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e), \u003cem\u003eElizabethkingia argenteiflava\u003c/em\u003e (\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e), \u003cem\u003eElizabethkingia occulta, Elizabethkingia ursingii\u003c/em\u003e, and \u003cem\u003eElizabethkingia bruuniana\u003c/em\u003e (\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e). \u003cem\u003eE. anopheles\u003c/em\u003e was isolated from the midgut of a mosquito (Anopheles gambiae) in 2011 (\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e). The first human infection with \u003cem\u003eE. anophelis\u003c/em\u003e was meningitis in a newborn in the Central African Republic in 2013 (\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e). In 2018, three new species were identified: \u003cem\u003eE. occulta, E. ursingii\u003c/em\u003e, and \u003cem\u003eE. bruuniana\u003c/em\u003e (\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eEnvironmental studies have shown that \u003cem\u003eElizabethkingia\u003c/em\u003e can survive in water supply systems and often colonizes sinks, basins, and faucets, creating a potential reservoir of infection within hospitals (\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e). \u003cem\u003eElizabethkingia\u003c/em\u003e can be introduced to patients through medical equipment contaminated with fluids (e.g., respirators, intubation tubes, fog tents, humidifiers, neonatal incubators, and freezers), and can also be transmitted through wet and dry materials and surfaces, including the hands of hospital staff. Hospital transmission of \u003cem\u003eElizabethkingia\u003c/em\u003e has also been reported in immunocompromised adults in intensive care units (ICUs). Nosocomial outbreaks of \u003cem\u003eElizabethkingia\u003c/em\u003e occur worldwide, especially infections involving ICU patients requiring ventilator support (\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e, \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e). Outbreaks have been mainly related to healthcare and, often, water sources (\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e, \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e). Evidence suggests that most human infections are caused by \u003cem\u003eE. anopheles\u003c/em\u003e (\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eThe importance of early detection and treatment has been further reinforced by the increasing number of \u003cem\u003eElizabethkingia\u003c/em\u003e infections worldwide in recent years, with high morbidity and mortality rates (\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e). Due to their Ambler class A serine extended-spectrum β-lactamase (ESBL) gene, \u003cem\u003eblaCME\u003c/em\u003e, and the Ambler class B metallo-β-lactamase (MBL) genes, \u003cem\u003eblaBlaB\u003c/em\u003e and \u003cem\u003eblaGOB\u003c/em\u003e, \u003cem\u003eElizabethkingia\u003c/em\u003e species are intrinsically resistant to a wide variety of β-lactams, contributing to their natural resistance to several commonly used carbapenem antibiotics. \u003cem\u003eElizabethkingia\u003c/em\u003e species are also known to be resistance to quinolones, owing to DNA mutations in their rotamase and/or topoisomerase IV genes (\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e, \u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e). \u003cem\u003eElizabethkingia\u003c/em\u003e has the unique ability to acquire multi-drug resistance and survive disinfectants, therefore spread between patients via human/inanimate host material in hospital environments is a concern. Therefore, it is critical to identify the source of infection and establish the kinetics of its spread within hospital environments (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e). \u003cem\u003eElizabethkingia\u003c/em\u003e-related infections are complicated by biofilm formation, intracellular invasion, and multidrug resistance of strains; the careful selection of appropriate antimicrobial agents is required.\u003c/p\u003e \u003cp\u003eThree species, \u003cem\u003eE. meningoseptica, E. miricola\u003c/em\u003e, and \u003cem\u003eE. anophelis\u003c/em\u003e, cannot be distinguished by their phenotypic characteristics, and are often misidentified by biochemical or other commercial systems because of the limited \u003cem\u003eElizabethkingia\u003c/em\u003e database available. Previous studies have misidentified \u003cem\u003eE. anophelis\u003c/em\u003e, \u003cem\u003eE. bruniana\u003c/em\u003e, \u003cem\u003eE. ursingii\u003c/em\u003e, and \u003cem\u003eE. occulta\u003c/em\u003e as \u003cem\u003eE. meningoseptica\u003c/em\u003e, suggesting an underestimation of the likelihood of infection with these species (\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e). Most studies investigating \u003cem\u003eElizabethkingia\u003c/em\u003e have used unreliable microbial identification methods; therefore, these studies present the clinical or molecular characteristics of all \u003cem\u003eElizabethkingia\u003c/em\u003e species, not each individual species. Despite their clinical significance, gaps remain in our understanding of the demographics, pathogenicity, and effective treatment options of \u003cem\u003eElizabethkingia\u003c/em\u003e infections.\u003c/p\u003e \u003cp\u003eIn this study, the epidemiology, clinical characteristics, and antibiotic susceptibility of \u003cem\u003eElizabethkingia\u003c/em\u003e isolates collected from a hospital affiliated with Nanchang University in 2022 and 2023 were analyzed using 16S rRNA sequencing. We evaluated the susceptibility of \u003cem\u003eElizabethkingia\u003c/em\u003e isolates to 16 antibiotics and compared the results of 16S rRNA sequencing with those of the VITEK MS assay to identify the strains to evaluate the feasibility of this mass spectrometry.\u003c/p\u003e"},{"header":"Methods","content":"\u003cp\u003e \u003cb\u003eClinical specimens and identification of\u003c/b\u003e \u003cb\u003eElizabethkingia\u003c/b\u003e \u003cb\u003eIsolates\u003c/b\u003e\u003c/p\u003e \u003cp\u003eClinical specimens for bacterial culture were collected from at the First Affiliated Hospital of Nanchang University, a tertiary comprehensive hospital in China with 6,100 beds, between January 2022 and December 2023. A total of 103 specimens were collected from 103 hospitalized patients who were isolated from a variety of sources. The species were initially identified using Vitek MS (bioM\u0026eacute;rieux). The isolates identified as \u003cem\u003eElizabethkingia spp\u003c/em\u003e. were frozen until use.\u003c/p\u003e \u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eSpecies Identification Using 16S rRNA Gene Sequencing\u003c/h2\u003e \u003cp\u003eThe 16S rRNA gene was amplified and sequenced using the universal primers 27F: 50- AGAGTTTGATCMTGGCTCAG-30 and 1492R:50-TACGGYTACCTTGTTACGACTT-3'(\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e). The PCR reaction mixture (50 mL) consisted of 1 uL of each primer, 6 uL of genomic DNA, and 25 uL of 5xPCR Master Mix. PCR was performed with the following conditions: denaturation at 95℃ for 5 minutes; 35 cycles of denaturation at 95℃ for 15 seconds, annealing at 56℃ for 15 seconds, and extension at 72℃ for 15 seconds; and a final extension at 72℃ for 5 minutes. The 1,488 bp product was analyzed via 1% agarose gel electrophoresis and visualized with ethidium bromide staining(\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e). The assembled 16S rRNA sequences were submitted to the National Center for Biotechnology Information website for comparison with the GenBank sequence database using the Basic Local Alignment Search Tool (\u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://blast.ncbi.nlm.nih.gov/Blast.cgi\u003c/span\u003e\u003cspan address=\"https://blast.ncbi.nlm.nih.gov/Blast.cgi\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e). The similarity of the 16S rRNA sequences of isolates to the type strains in the GenBank sequence databases was examined using the following reference sequences: \u003cem\u003eE. anophelis\u003c/em\u003e strain R26, GenBank accession number NR_116021.1; \u003cem\u003eE. meningoseptica\u003c/em\u003e type strain 13253, NR_042267.1; \u003cem\u003eE. bruuniana\u003c/em\u003e strain SBRL-21-126, NZ_JAMBNJ010000000; and \u003cem\u003eE. ursingii\u003c/em\u003e strain G4122,NZ_LNOK01000023)(\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e). All clinical isolates were identified by Vitek MS and 16sRNA gene sequencing, and with 16sRNA as the gold standard, we compared the accuracy of Vitek MS in identifying \u003cem\u003eElizabethkingia\u003c/em\u003e isolates (\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e).\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec4\" class=\"Section2\"\u003e \u003ch2\u003eAntimicrobial susceptibility testing\u003c/h2\u003e \u003cp\u003e \u003cem\u003eIn vitro\u003c/em\u003e drug susceptibility testing was conducted using the Vitek2-Compact fully automated microbial analysis system. Interpretations of resistance (R), intermediate resistance (I), and sensitivity (S) were performed in accordance with the criteria established by the Clinical Laboratory Standards Institute (M100-S27). PCR amplification was performed to detect the presence of seven resistance genes (\u003cem\u003eblaBlaB\u003c/em\u003e, \u003cem\u003eblaGOB\u003c/em\u003e, and \u003cem\u003eblaCME\u003c/em\u003e) as previously described (\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e). The amplification primers, systems, and conditions were obtained from the literature.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec5\" class=\"Section2\"\u003e \u003ch2\u003eMolecular Typing\u003c/h2\u003e \u003cp\u003ePulsed-field gel electrophoresis (PFGE) was utilized to appraise the homology of all strains(\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e). Genomic DNA of \u003cem\u003eElizabethkingia\u003c/em\u003e was fabricated via digestion with the restriction enzyme XhoI for 4 hours at 37\u0026deg;C. The molecular size marker of strain Braenderup H9812 was processed with XbaI(\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e). Furthermore, the DNA fragments were segregated by employing the CHEF Mapper XA System (Bio-Rad) at 6V/cm for 18h. PFGE band profiles were analyzed with BioNumerics 8.0. Similarity matrices were computed using Dice's coefficients with 1.5% optimization and 1.5% band matching tolerance. Dendrograms were constructed using the unweighted pair group method with arithmetic averages (UPGMA) (\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e). Isolates were categorized into PFGE subtypes (\u0026ge;\u0026thinsp;95% similarity), PFGE types (85\u0026ndash;95% similarity), or different types (\u0026lt;\u0026thinsp;85% similarity) (\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e).\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec6\" class=\"Section2\"\u003e \u003ch2\u003eStatistical Analysis\u003c/h2\u003e \u003cp\u003eThe data were analyzed with SPSS 26.0 statistical software. Categorical data were expressed as frequencies and percentages. Chi-squared or Fisher\u0026rsquo;s exact tests were used to compare categorical variables (sex, underlying diseases, operation, indwelling device, ICU admission, principal disease, fungal infection, and COVID-19). Continuously quantitative data (age, hospitalization duration, temperature, white blood cell count, hemoglobin, neutrophil percentage, platelet count, lymphocyte count, lymphocyte percentage, proealcitonin, C-reactive protine, and serum creatinine) were expressed as the mean\u0026thinsp;\u0026plusmn;\u0026thinsp;standard deviation and compared by \u003cem\u003eT\u003c/em\u003e test. A \u003cem\u003eP\u003c/em\u003e-value of \u0026lt;\u0026thinsp;0.05 was considered statistically significant.\u003c/p\u003e \u003c/div\u003e"},{"header":"Results","content":"\u003cp\u003e\u003cstrong\u003eIdentification and Prevalence of\u003c/strong\u003e \u003cstrong\u003eElizabethkingia\u003c/strong\u003e \u003cstrong\u003eIsolates\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eA total of 103 \u003cem\u003eElizabethkingia\u003c/em\u003e isolates, identified by conventional methods, were collected at a university-affiliated hospital in 2022 and 2023. Among the 103 isolates, the species identified using 16S rRNA gene sequencing were 92 isolates (89.3%) of \u003cem\u003eE. anophelis\u003c/em\u003e (99.4\u0026ndash;100.0% nucleotide identity to \u003cem\u003eE. anophelis\u003c/em\u003e type strain R16), eight isolates (7.3%) of \u003cem\u003eE. meningoseptica\u003c/em\u003e (99.5\u0026ndash;99.9% nucleotide identity to \u003cem\u003eE. meningoseptica\u003c/em\u003e type strain ATCC 13253), two isolates (1.9%) of \u003cem\u003eE. bruuniana\u003c/em\u003e, and one isolate (1.0%) of \u003cem\u003eE. ursingii\u003c/em\u003e. But we found ambiguity in the identification of \u003cem\u003eE. bruuniana\u003c/em\u003e and \u003cem\u003eE. ursingii\u003c/em\u003e .\u003c/p\u003e\n\u003cp\u003eA matrix-assisted laser desorption ionization time-of-flight (MALDI-TOF) Vitek MS system with an amended database was used and its feasibility for the identification of \u003cem\u003eElizabethkingia\u003c/em\u003e isolates was evaluated. Using VITEK MS, 80.6% of \u003cem\u003eElizabethkingia\u003c/em\u003e isolates (83 of 103) were correctly identified. VITEK MS identified 80 strains (87.0%) of \u003cem\u003eE. anophelis\u003c/em\u003e and correctly identified three strains (37.3%) of \u003cem\u003eE. meningoseptica\u003c/em\u003e, demonstrating improved accuracy compared with other methods (Table \u003cspan class=\"InternalRef\"\u003e1\u003c/span\u003e). Of these, seven (6.8%) strains of \u003cem\u003eE. anophelis\u003c/em\u003e were misidentified as \u003cem\u003eE. miricola\u003c/em\u003e, five (4.8%) strains of \u003cem\u003eE. anophelis\u003c/em\u003e were misidentified as \u003cem\u003eE. meningoseptica\u003c/em\u003e, five (4.8%) strains of \u003cem\u003eE. meningoseptica\u003c/em\u003e were misidentified as \u003cem\u003eE. anophelis\u003c/em\u003e, and one (1%) strain of \u003cem\u003eE. ursingii\u003c/em\u003e was misidentified as \u003cem\u003eE. anophelis\u003c/em\u003e. Further, there was one instance each of \u003cem\u003eE. bruuniana\u003c/em\u003e being misidentified as \u003cem\u003eE. miricola\u003c/em\u003e (1%) and \u003cem\u003eE. bruuniana\u003c/em\u003e being misidentified as \u003cem\u003eE. anophelis\u003c/em\u003e (1%). These results imply that Vitek MS may be unreliable in identifying \u003cem\u003eE. meningoseptica\u003c/em\u003e and \u003cem\u003eE. miricola\u003c/em\u003e. Additionally, 16 sputum samples showed concomitant isolates of other bacterial species, such as \u003cem\u003eAcinetobacter baumannii\u003c/em\u003e, \u003cem\u003eAcinetobacter SPP, Klebsiella pneumoniae\u003c/em\u003e, and\u0026nbsp;\u003cem\u003eStenotrophomonas maltophilia\u003c/em\u003e.\u003c/p\u003e\n\u003cdiv class=\"gridtable\"\u003e\u0026nbsp;\u003ctable id=\"Tab1\" border=\"1\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\n \u003cp\u003eComparison of Vitek MS with 16S rRNA gene sequencing in \u003cem\u003eElizabethkingia\u003c/em\u003e isolates identification\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003ccolgroup cols=\"7\"\u003e\u003c/colgroup\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\" rowspan=\"3\"\u003e\n \u003cp\u003e16S rRNA sequencing\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\" colspan=\"6\"\u003e\n \u003cp\u003eVitek MS\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003cth align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003e\u003cem\u003eE. anophelis\u003c/em\u003e\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003e\u003cem\u003eE. meningoseptica\u003c/em\u003e\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003e\u003cem\u003eE. miricola\u003c/em\u003e\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eCorrect\u003c/p\u003e\n \u003cp\u003ediscrimination\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eFalse\u003c/p\u003e\n \u003cp\u003ediscrimination\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eCorrect discrimination\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eFalse discrimination\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eCorrect discrimination\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eFalse discrimination\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eE. anophelis\u003c/strong\u003e\u003cstrong\u003e(n\u0026thinsp;=\u0026thinsp;92)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e80(87.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e5(5.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e7(7.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eE. meningoseptica\u003c/strong\u003e\u003cstrong\u003e(n\u0026thinsp;=\u0026thinsp;8)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e5(62.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e3(37.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eE. bruuniana\u003c/strong\u003e\u003cstrong\u003e(n\u0026thinsp;=\u0026thinsp;2)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e1(50.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e1(50.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eE. ursingii\u003c/strong\u003e\u003cstrong\u003e(n\u0026thinsp;=\u0026thinsp;1)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e1(100.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n\u003c/div\u003e\n\u003cp\u003e\u003cstrong\u003eClinical Characteristics of\u003c/strong\u003e \u003cstrong\u003eElizabethkingia\u003c/strong\u003e \u003cstrong\u003eInfections\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAmong the 103 \u003cem\u003eElizabethkingia\u003c/em\u003e isolates, including 36 strains collected in 2022 and 67 strains collected in 2023, the most common site of isolation was the respiratory tract (90.3%), followed by the blood (3.9%). Other sites of isolation included the cerebrospinal fluid (1.9%), urine (1.9%), pleural fluid (1%), and catheter tips (1%) (Fig.\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e1\u003c/span\u003e). Of these patients, 74.8% were male and 25.2% were female; the average age of the patients was 60\u0026thinsp;\u0026plusmn;\u0026thinsp;18 years (excluding one 13-day-old patient) (Table\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e2\u003c/span\u003e). Prolonged hospital stays (\u0026ge;\u0026thinsp;2 weeks) was observed in 97 patients. Comorbidities were identified in most hospitalized patients, with hypertension being the most prevalent underlying disease (37/103; 35.9%), followed by diabetes mellitus (18/103; 17.5%), and chronic obstructive pulmonary disease (11/103; 10.7%). A large portion of the patients had nervous system disease (59.2%), while 41.4% had cardiovascular disease, and 38.3% had experienced trauma. Furthermore, 88 (85.4%) patients were treated in the ICU, 67 (65.0%) underwent surgery, and 82 (79.6%) received mechanical ventilation. Central venous catheters were placed in 75 patients (72.8%).\u003c/p\u003e\n\u003cp\u003e\u003cbr\u003e\u003c/p\u003e\n\u003cp\u003eA total of 36 deaths occurred, corresponding to a mortality rate of 35.0%. Compared to the survivors, the 36 patients who died were significantly older (67\u0026thinsp;\u0026plusmn;\u0026thinsp;16 vs 57\u0026thinsp;\u0026plusmn;\u0026thinsp;18 years; \u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.006), and had significantly more central venous catheters (86.1 vs. 65.7%, respectively; \u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.026), and Foley\u0026rsquo;s catheters (88.9 vs. 71.6%;\u0026nbsp;\u003cem\u003eP\u003c/em\u003e =\u003c/p\u003e\n\u003cdiv class=\"gridtable\"\u003e\n \u003cdiv align=\"char\" class=\"colspec\"\u003e\u003cbr\u003e\u003c/div\u003e\u0026nbsp;\u003ctable id=\"Tab2\" border=\"1\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\n \u003cp\u003eFactors associated with mortality in patients with Elizabethkingia infections\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003ccolgroup cols=\"5\"\u003e\u003c/colgroup\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\u0026nbsp;\u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eTotal(n\u0026thinsp;=\u0026thinsp;103)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eSurvivors (n\u0026thinsp;=\u0026thinsp;67)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eDeaths (n\u0026thinsp;=\u0026thinsp;36)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003ep-Value\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eAge (Years)(mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e60\u0026thinsp;\u0026plusmn;\u0026thinsp;18\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e57\u0026thinsp;\u0026plusmn;\u0026thinsp;18\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e67\u0026thinsp;\u0026plusmn;\u0026thinsp;16\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.006\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eMale, n(%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e77(74.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e47(70.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e30(83.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.142\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eHospitalization duration(days) (mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e43\u0026thinsp;\u0026plusmn;\u0026thinsp;31\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e45\u0026thinsp;\u0026plusmn;\u0026thinsp;35\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e35\u0026thinsp;\u0026plusmn;\u0026thinsp;17\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.04\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eOperation, n(%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e67(65.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e49(73.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e18(50%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.019\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eIndwelling device, n (%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMechanical ventilation, n(%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e82(79.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e52(77.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e30(83.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.492\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eCentral venous catheter n(%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e75(72.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e44(65.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e31(86.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.026\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNasogastric tube n(%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e73(70.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e45(67.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e28(77.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.258\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eFoley\u0026rsquo;s catheter, n(%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e80(77.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e48(71.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e32(88.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.045\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eSurgical puncture or drain n(%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e47(45.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e31(46.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e16(44.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.859\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eICU admission, n(%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e88(85.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e53(79.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e35(97.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.013\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eCOVID-19, n(%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e11(10.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2(3.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e9(25%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eFungal infection, n(%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e42(40.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e23(34.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e19(52.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.069\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eUnderlying diseases, n(%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eDiabetes mellitus, n(%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e18(17.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e12(17.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e6(16.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.874\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eHypertension, n(%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e37(35.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e24(35.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e13(36.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.977\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eChronic obstructive pulmonary disease, n(%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e11(10.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3(4.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e8(22.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.005\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003ePrinciple disease, n(%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNervous system, n(%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e61(59.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e36(53.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e25(69.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.122\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMalignancy, n(%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e5(4.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e4(6.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1(2.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.472\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eTrauma, n(%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e40(38.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e30(44.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e11(30.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.16\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eCardiovascular, n(%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e43(41.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e28(41.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e15(41.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.99\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eDigestive, n(%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e21(20.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e17(25.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e4(11.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.087\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eRespiratory, n(%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e35(34.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e17(25.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e18(50%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.012\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eTemperature(℃) (mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e37.7\u0026thinsp;\u0026plusmn;\u0026thinsp;0.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e37.6\u0026thinsp;\u0026plusmn;\u0026thinsp;0.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e37.8\u0026thinsp;\u0026plusmn;\u0026thinsp;0.9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.338\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eLaboratory data\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eWhite blood cell count (\u0026times;10^9/L) (mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e11.6\u0026thinsp;\u0026plusmn;\u0026thinsp;7.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e10.9\u0026thinsp;\u0026plusmn;\u0026thinsp;7.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e13.0\u0026thinsp;\u0026plusmn;\u0026thinsp;7.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.15\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eHemoglobin (g/dL) (mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e86.7\u0026thinsp;\u0026plusmn;\u0026thinsp;20.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e87.7\u0026thinsp;\u0026plusmn;\u0026thinsp;16.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e84.8\u0026thinsp;\u0026plusmn;\u0026thinsp;27.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.496\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePlatelet count (\u0026times;10^9/L) (mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e226.8\u0026thinsp;\u0026plusmn;\u0026thinsp;154.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e254.1\u0026thinsp;\u0026plusmn;\u0026thinsp;146.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e175.8\u0026thinsp;\u0026plusmn;\u0026thinsp;156.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.013\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNeutrophil percentage(%)(mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e78.4\u0026thinsp;\u0026plusmn;\u0026thinsp;14.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e77.6\u0026thinsp;\u0026plusmn;\u0026thinsp;14.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e79.9\u0026thinsp;\u0026plusmn;\u0026thinsp;15.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.455\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eLymphocyte count(\u0026times;10^9/L) (mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.0\u0026thinsp;\u0026plusmn;\u0026thinsp;0.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.0\u0026thinsp;\u0026plusmn;\u0026thinsp;0.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.1\u0026thinsp;\u0026plusmn;\u0026thinsp;0.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.563\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eLymphocyte percentage(%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e11.1\u0026thinsp;\u0026plusmn;\u0026thinsp;8.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e11.9\u0026thinsp;\u0026plusmn;\u0026thinsp;9.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e9.4\u0026thinsp;\u0026plusmn;\u0026thinsp;6.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.167\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eC-reactive protine(mg/L)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e66.25\u0026thinsp;\u0026plusmn;\u0026thinsp;54.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e50.88\u0026thinsp;\u0026plusmn;\u0026thinsp;38.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e94.4\u0026thinsp;\u0026plusmn;\u0026thinsp;65.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eSerum creatinine (mg/dL) (mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e106.4\u0026thinsp;\u0026plusmn;\u0026thinsp;74.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e85.9\u0026thinsp;\u0026plusmn;\u0026thinsp;55.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e144.5\u0026thinsp;\u0026plusmn;\u0026thinsp;88.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eProealcitonin (ng/mL) (mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2.4\u0026thinsp;\u0026plusmn;\u0026thinsp;5.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.2\u0026thinsp;\u0026plusmn;\u0026thinsp;3.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e4.4\u0026thinsp;\u0026plusmn;\u0026thinsp;7.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.017\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n\u003c/div\u003e\n\u003cp\u003e0.045) placed. Furthermore, the distribution of primary diseases showed a significant difference, with a higher percentage of respiratory diseases in patients who died compared to survivors (50.0 vs. 25.4%; \u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.012); COVID-19 was the most significant risk factor associated with mortality (25 vs. 3%; \u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.001). Laboratory data showed that C-reactive protein, serum creatinine, and procalcitonin levels were significantly different between the survival and death groups (\u0026nbsp;\u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05); however, white blood cell count, hemoglobin level, neutrophil percentage, lymphocyte count, and lymphocyte percentage showed no significant differences.\u003c/p\u003e\n\u003cdiv class=\"gridtable\"\u003e\u0026nbsp;\u003ctable id=\"Tab3\" border=\"1\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\n \u003cp\u003eAntimicrobial Susceptibilities of 103 Elizabethkingia Isolates Determined by the Vitek2-Compact fully automated microbial analysis system\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003ccolgroup cols=\"16\"\u003e\u003c/colgroup\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\" colspan=\"16\"\u003e\n \u003cp\u003eNo. of isolates with result/total no. of isolates tested (%)\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\u0026nbsp;\u003c/th\u003e\n \u003cth align=\"left\" colspan=\"3\"\u003e\n \u003cp\u003e\u003cem\u003eE.Anophelis\u003c/em\u003e\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\" colspan=\"3\"\u003e\n \u003cp\u003e\u003cem\u003eE.Meningoseptic\u003c/em\u003e\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\" colspan=\"3\"\u003e\n \u003cp\u003e\u003cem\u003eE.Bruuniana\u003c/em\u003e\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\" colspan=\"3\"\u003e\n \u003cp\u003e\u003cem\u003eE.Ursingii\u003c/em\u003e\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\" colspan=\"3\"\u003e\n \u003cp\u003eTotal isolates\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eantimicrobial agents\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eS\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eI\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eR\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eS\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eI\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eR\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eS\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eI\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eR\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eS\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eI\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eR\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eS\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eI\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eR\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePiperacillin-tazobactam\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e26/90(28.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3/90(3.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e61/90(67.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e6/8(75)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2/8(\u003cspan class=\"CitationRef\"\u003e25\u003c/span\u003e)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1/2(50)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1/2(50)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1/1(100)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e32/1(31.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e4/101\u003c/p\u003e\n \u003cp\u003e(4.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e65/101\u003c/p\u003e\n \u003cp\u003e(63.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eTicarcillin-clavulanic acid\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2/55(3.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e6/55(10.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e47/55(85.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2/2(100)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1/1(100)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1/1(100)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2/59(3.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e6/59(10.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e51/59(86.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eCeftazidime\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1/68(1.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e67/68(98.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2/2(100)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2/2(100)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1/1(100)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1/73(1.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e72/73(98.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eCefepime\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e5/91(5.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e86/91(94.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e8/8(100)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2/2(100)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1/1(100)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e5/102(4.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e97/102(95.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eCefoperazone-sulbactam\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003cp\u003e(12.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2/16\u003c/p\u003e\n \u003cp\u003e(12.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e12/16\u003c/p\u003e\n \u003cp\u003e(75)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1/1(100)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1/1(100)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2/18(11.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2/18(11.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e14/18(77.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eAztreonam\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e91/91\u003c/p\u003e\n \u003cp\u003e(100)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e8/8(100)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2/2(100)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1/1(100)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e102/102(100)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eImipenem\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2/92\u003c/p\u003e\n \u003cp\u003e(2.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e90/92\u003c/p\u003e\n \u003cp\u003e(97.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e8/8(100)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2/2(100)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1/1(100)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2/103(1.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e101/103(98.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMeropenem\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2/62\u003c/p\u003e\n \u003cp\u003e(3.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e60/62\u003c/p\u003e\n \u003cp\u003e(96.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2/2(100)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1/1(100)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1/1(100)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2/66(3.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e64/66(97.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eAmikacin\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3/92\u003c/p\u003e\n \u003cp\u003e(3.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1/92\u003c/p\u003e\n \u003cp\u003e(1.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e88/92\u003c/p\u003e\n \u003cp\u003e(95.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e8/8(100)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1/2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1/2\u003c/p\u003e\n \u003cp\u003e(50)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1/1(100)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e4/103\u003c/p\u003e\n \u003cp\u003e(3.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1/103\u003c/p\u003e\n \u003cp\u003e(1.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e98/103\u003c/p\u003e\n \u003cp\u003e(95.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eCiprofloxacin\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e21/92\u003c/p\u003e\n \u003cp\u003e(22.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3/92\u003c/p\u003e\n \u003cp\u003e(3.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e68/92\u003c/p\u003e\n \u003cp\u003e(73.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1/8\u003c/p\u003e\n \u003cp\u003e(12.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e7/8\u003c/p\u003e\n \u003cp\u003e(87.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2/2(100)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1/1(100)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e24/103\u003c/p\u003e\n \u003cp\u003e(23.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3/103\u003c/p\u003e\n \u003cp\u003e(2.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e76/103\u003c/p\u003e\n \u003cp\u003e(73.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eLevofloxacin\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e30/92\u003c/p\u003e\n \u003cp\u003e(32.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e62/92\u003c/p\u003e\n \u003cp\u003e(67.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1/8\u003c/p\u003e\n \u003cp\u003e(12.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e7/8\u003c/p\u003e\n \u003cp\u003e(87.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1/2\u003c/p\u003e\n \u003cp\u003e(50)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1/2\u003c/p\u003e\n \u003cp\u003e(50)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1/1(100)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e32/103\u003c/p\u003e\n \u003cp\u003e(31.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e71/103\u003c/p\u003e\n \u003cp\u003e(68.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eTrimethoprim-sulfamethoxazole\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e71/89\u003c/p\u003e\n \u003cp\u003e(79.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e18/89\u003c/p\u003e\n \u003cp\u003e(20.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e8/8(100)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1/2\u003c/p\u003e\n \u003cp\u003e(50)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1/2\u003c/p\u003e\n \u003cp\u003e(50)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1/1(100)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e81/100\u003c/p\u003e\n \u003cp\u003e(81)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e19/100\u003c/p\u003e\n \u003cp\u003e(\u003cspan class=\"CitationRef\"\u003e19\u003c/span\u003e)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eDoxycycline\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e54/61\u003c/p\u003e\n \u003cp\u003e(88.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1/61\u003c/p\u003e\n \u003cp\u003e(1.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e6/61\u003c/p\u003e\n \u003cp\u003e(9.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2/2(100)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1/1(100)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1/1(100)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e58/65\u003c/p\u003e\n \u003cp\u003e(89.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1/65\u003c/p\u003e\n \u003cp\u003e(1.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e6/65\u003c/p\u003e\n \u003cp\u003e(9.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMinocycline\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e59/61\u003c/p\u003e\n \u003cp\u003e(96.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2/61\u003c/p\u003e\n \u003cp\u003e(3.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2/2(100)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1/1(100)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1/1(100)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e63/65\u003c/p\u003e\n \u003cp\u003e(96.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2/65\u003c/p\u003e\n \u003cp\u003e(3.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eGentamicin\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1/31\u003c/p\u003e\n \u003cp\u003e(3.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e4/31\u003c/p\u003e\n \u003cp\u003e(12.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e26/31\u003c/p\u003e\n \u003cp\u003e(83.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e6/6(100)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1/1(100)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1/38\u003c/p\u003e\n \u003cp\u003e(2.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e4/38\u003c/p\u003e\n \u003cp\u003e(10.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e33/38\u003c/p\u003e\n \u003cp\u003e(86.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eTobramycin\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3/92\u003c/p\u003e\n \u003cp\u003e(3.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e89/92\u003c/p\u003e\n \u003cp\u003e(96.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e8/8(100)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1/2\u003c/p\u003e\n \u003cp\u003e(50)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1/2\u003c/p\u003e\n \u003cp\u003e(50)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1/1(100)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e4/103\u003c/p\u003e\n \u003cp\u003e(3.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e99/103\u003c/p\u003e\n \u003cp\u003e(96.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n\u003c/div\u003e\n\u003cp\u003e\u003cstrong\u003eAntimicrobial susceptibilities and Genotype of\u003c/strong\u003e \u003cstrong\u003eElizabethkingia\u003c/strong\u003e \u003cstrong\u003eIsolates\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe drug susceptibilities of the 103 \u003cem\u003eElizabethkingia\u003c/em\u003e isolates were determined using the Vitek2-Compact fully automated microbial analysis system (Table\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e3\u003c/span\u003e). All isolates were resistant to aztreonam. All 103 isolates were susceptible to at least one antimicrobial agent tested. Sixty-three of 65 isolates (96.9%) tested were susceptible to minocycline, 58/65 (89.3%) were susceptible to\u003c/p\u003e\n\u003cp\u003edoxycycline, and 81/100 (81.0%) were susceptible to trimethoprim-sulfamethoxazole. Over 95% of the tested isolates were resistant to ceftazidime, imipenem, meropenem, amikacin and tobramycin. In addition, one \u003cem\u003eE. anophelis\u003c/em\u003e isolate was resistant to all antibiotics tested; however, most\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eElizabethkingia\u003c/em\u003e isolates were only sensitive to two or three antibiotics tested (Table \u003cspan class=\"InternalRef\"\u003e4\u003c/span\u003e).\u003c/p\u003e\n\u003cp\u003eA total of 69 \u003cem\u003eElizabethkingia\u003c/em\u003e strains carried \u0026beta;-lactamase genes. Of these, 68 \u003cem\u003eElizabethkingia\u003c/em\u003e isolates carried \u003cem\u003eblaBlaB\u003c/em\u003e and seven carried \u003cem\u003eblaCME\u003c/em\u003e; none carried \u003cem\u003eblaGOB\u003c/em\u003e. Six \u003cem\u003eElizabethkingia\u003c/em\u003e isolates harbored both \u003cem\u003eblaBlaB\u003c/em\u003e and \u003cem\u003eblaCME\u003c/em\u003e genes (Fig. \u003cspan class=\"InternalRef\"\u003e2\u003c/span\u003e). Accordingly, strains carrying these resistance genes were found to be resistant to ceftazidime, cefepime, meropenem, and imipenem, with resistance rates\u0026thinsp;\u0026gt;\u0026thinsp;90%; this effect was particularly pronounced in \u003cem\u003eE. anophelis\u003c/em\u003e and \u003cem\u003eE. meningoseptica\u003c/em\u003e. Strains with \u003cem\u003eGryA\u003c/em\u003e, \u003cem\u003eGyrB\u003c/em\u003e, \u003cem\u003eParC\u003c/em\u003e, and \u003cem\u003eParE\u003c/em\u003e genes were resistant to fluoroquinolones, with approximately 30% susceptibility to ciprofloxacin, which was higher in strains carrying the\u0026nbsp;\u003cem\u003eRND\u003c/em\u003e gene for the efflux pump.\u003c/p\u003e\n\u003cdiv class=\"gridtable\"\u003e\u0026nbsp;\u003ctable id=\"Tab4\" border=\"1\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\n \u003cp\u003eThe number of susceptible antibiotics of 103 isolates of \u003cem\u003eElizabethkingia\u003c/em\u003e isolates\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003ccolgroup cols=\"6\"\u003e\u003c/colgroup\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\" rowspan=\"2\"\u003e\n \u003cp\u003eNumber of Susceptible\u003c/p\u003e\n \u003cp\u003eAntibiotics\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\" rowspan=\"2\"\u003e\n \u003cp\u003eAll Isolates (n\u0026thinsp;=\u0026thinsp;103)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\u0026nbsp;\u003c/th\u003e\n \u003cth align=\"left\" colspan=\"3\"\u003e\n \u003cp\u003eNumber of Episodes (%)\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003eE.Anophelis\u003c/em\u003e(92)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003eE.Meningoseptic\u003c/em\u003e(\u003cspan class=\"CitationRef\"\u003e8\u003c/span\u003e)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003eE.Bruuniana\u003c/em\u003e(\u003cspan class=\"CitationRef\"\u003e2\u003c/span\u003e)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003eE.Ursingii\u003c/em\u003e(\u003cspan class=\"CitationRef\"\u003e1\u003c/span\u003e)\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1(1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e1(1.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e5(4.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e5(5.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e29(28.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e24(26.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e5(62.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e42(40.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e38(41.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2(25%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1(50%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1(100%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e17(16.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e15(16.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1(12.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1(50%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e6(5.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e6(6.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2(1.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e2(2.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1(1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e1(1.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n\u003c/div\u003e\n\u003cp\u003e\u003cstrong\u003eMolecular typing of\u003c/strong\u003e \u003cstrong\u003eElizabethkingia\u003c/strong\u003e \u003cstrong\u003eIsolates\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNineteen \u003cem\u003eElizabethkingia\u003c/em\u003e isolates were found to be resistant to XhoI digestion. The remaining 84 isolates clustered into 29 different pulsed-field gel electrophoresis (PFGE) types (Fig. \u003cspan class=\"InternalRef\"\u003e2\u003c/span\u003e). In particular, 74 \u003cem\u003eE. anophelis\u003c/em\u003e isolates were divided into 22 clusters designated A\u0026ndash;V, seven \u003cem\u003eE. meningoseptica\u003c/em\u003e isolates were divided into five clusters designated A\u0026ndash;E, and two \u003cem\u003eE. bruuniana\u003c/em\u003e and one \u003cem\u003eE. ursingii\u003c/em\u003e isolate were divided into two clusters designated A and B. PFGE typing was most common for the J-type with 42 strains, 14 of which belonged to the same subtype. Of these 14 strains, all were from patients admitted to the ICU of the same department within a three month span from which clonal strains of the same subtype were collected (most from sputum) indicating the presence of clonal transmission in the ICU. Most patients with the same subtype experienced cerebrovascular accidents, and received mechanical ventilation and indwelling tubes during hospitalization. Similar antimicrobial susceptibility patterns were observed for different subtypes of the same clustered strains.\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003e\u003cem\u003eElizabethkingia\u003c/em\u003e isolates cause serious nosocomial infections and outbreaks worldwide, but have received relatively little attention. In this study, we used 16S rRNA gene sequencing as a reference method for the species identification of \u003cem\u003eElizabethkingia spp\u003c/em\u003e. collected over two years and analyzed the characteristics of \u003cem\u003eElizabethkingia spp\u003c/em\u003e. obtained from clinical samples. We found that \u003cem\u003eE. anophelis\u003c/em\u003e, but not \u003cem\u003eE. meningoseptica\u003c/em\u003e, accounted for the majority of human infections with the genus \u003cem\u003eElizabethkingia,\u003c/em\u003e and that the isolation rate of \u003cem\u003eElizabethkingia\u003c/em\u003e almost doubled from 36 strains collected in 2022 to 67 strains in 2023, with increasing detection of \u003cem\u003eE. anophelis\u003c/em\u003e. In fact, evidence suggests that \u003cem\u003eE. anopheles,\u003c/em\u003e rather than \u003cem\u003eE. meningoseptica,\u003c/em\u003e dominates \u003cem\u003eElizabethkingia\u003c/em\u003e in clinical settings\u0026nbsp;(19). Therefore, we must focus on nosocomial \u003cem\u003eElizabethkingia\u003c/em\u003e infections.\u003c/p\u003e\n\u003cp\u003eAdvances in microbial identification techniques have made it possible to identify several emerging unusual bacteria that cause disease, primarily in immunocompromised patients. Traditional identification systems are poor at identifying rare species and can easily lead to misidentification, misdiagnosis, treatment failure, and underestimation of the incidence of infection\u0026nbsp;(20). MALDI-TOF, Vitek mass spectrometry (VMS), and molecular identification techniques (16S rRNA, rpoB gene sequencing, and whole genome sequencing) have become useful tools for accurate identification of microorganisms\u0026nbsp;(17, 21). These tools have an excellent discrimination ability, especially for rare opportunistic bacteria. In this study, we found ambiguity in the identification of Ebr97, Ebr131, and Eur74 by 16S rRNA gene sequencing, which may have been due to the presence of multiple copies of the different sequences, as well as the fact these are highly variable regions of 16S rRNA\u0026nbsp;(16). PFGE mapping showed better resolution of clonal relationships, indicating that Ebr131 is more closely related to Ebr97, with a similarity of 85.7%. The \u003cem\u003erpoB\u003c/em\u003e gene is a single-copy gene with a higher phylogenetic evolutionary resolution than the 16S rRNA genes, thus allows for accurate differentiation of \u003cem\u003eElizabethkingia\u003c/em\u003e at the species level\u0026nbsp;(9, 17).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eStudies have shown that most patients with \u003cem\u003eElizabethkingia\u003c/em\u003e infections have\u0026nbsp;underlying\u0026nbsp;chronic diseases such as diabetes, cardiovascular diseases, and pulmonary diseases\u0026nbsp;(22, 23). Our study yielded similar results. Previous studies have shown that \u003cem\u003eE. meningoseptica\u003c/em\u003e is commonly isolated from ICUs in India\u0026nbsp;(24, 25)\u0026nbsp;and Taiwan\u0026nbsp;(26). In the present study,\u0026nbsp;the emergency ICU, trauma ICU, and general ICU were ranked in the top three\u0026nbsp;\u003cem\u003eElizabethkingia\u0026nbsp;\u003c/em\u003esources. These data consistently suggest that\u0026nbsp;\u003cem\u003eElizabethkingia\u003c/em\u003e favors infection in immunocompromised patients. In patients infected with \u003cem\u003eElizabethkingia\u003c/em\u003e, the mortality rate ranges from 20 to 40%\u0026nbsp;(27). The major risk factors for patients with \u003cem\u003eElizabethkingia\u003c/em\u003e infection include ICU admission, surgery,\u0026nbsp;and the use of an\u0026nbsp;indwelling device. Other risk factors include COVID-19, prolonged hospitalization,\u0026nbsp;and underlying diseases\u0026nbsp;(28). In this study, COVID-19, respiratory illness, mechanical ventilation, and central venous cannulation were risk factors for mortality in patients with \u003cem\u003eElizabethkingia\u003c/em\u003e infection. \u003cem\u003eElizabethkingia\u003c/em\u003e can form biofilms in wet environments or on water-related equipment, facilitating its spread in hospital environments\u0026nbsp;(28, 29). \u003cem\u003eElizabethkingia\u003c/em\u003e was identified in the ward during environmental surveillance sampling;\u0026nbsp;a retrospective review of clinical data revealed that\u0026nbsp;\u003cem\u003eElizabethkingia\u003c/em\u003e had also been identified in the sputum of patients admitted to the ward in the previous ten days, leading to the hypothesis that transmission of this bacterium may occur between caregivers and patients, and that environmental surfaces and shared medical equipment may also place patients at risk of \u003cem\u003eElizabethkingia\u003c/em\u003e infection\u0026nbsp;(30).\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eElizabethkingia\u003c/em\u003e infections are challenging because they tend to exhibit inherent resistance to antimicrobial agents (including beta-lactams and inhibitors, aminoglycosides, macrolides, tetracycline, vancomycin, and carbapenems)\u0026nbsp;(16). Genomic and proteomic analyses have confirmed the presence of multidrug resistance genes and drug efflux systems in \u003cem\u003eElizabethkingia\u003c/em\u003e (31, 32). These strains showed differential susceptibilities to doxycycline, ceftazidime, imipenem, meropenem, amikacin, and tobramycin. The high prevalence of \u003cem\u003eblaBlaB\u003c/em\u003e and \u003cem\u003eblaCME\u003c/em\u003e genes in the present study is consistent with broad-spectrum resistance to beta-lactams, including carbapenems. Several genes associated with drug resistance have been identified in \u003cem\u003eElizabethkingia\u003c/em\u003e. MBL genes are of global concern as they can confer resistance to carbapenems and almost all β-lactams\u0026nbsp;(33). \u003cem\u003eElizabethkingia\u003c/em\u003e is the only organism known to carry two distinct MBL genes (\u003cem\u003eblaBlaB\u003c/em\u003e and \u003cem\u003eblaGOB\u003c/em\u003e) and the \u003cem\u003eblaCME\u003c/em\u003e gene, which can confer resistance to cephalosporins\u0026nbsp;(21). Resistance genes, including \u003cem\u003egyrA, gyrB, parC,\u0026nbsp;\u003c/em\u003eand\u003cem\u003e\u0026nbsp;parE\u003c/em\u003e, and efflux pump genes, including \u003cem\u003eRND, MFS, MATE,\u0026nbsp;\u003c/em\u003eand\u003cem\u003e\u0026nbsp;ABC\u003c/em\u003e, were detected in \u003cem\u003eElizabethkingia\u003c/em\u003e isolates. The presence of multiple drug resistance genes in \u003cem\u003eElizabethkingia\u003c/em\u003e increases the difficulty of clinical treatment\u0026nbsp;(27).\u003c/p\u003e\n\u003cp\u003ePFGE typing reveals genetic diversity and clonal transmission. Although \u003cem\u003eE. anophelis\u003c/em\u003e is genotypically highly diverse, clonal transmission has been observed in several pairs of patients from the same or different departments. From April to August in 2022, \u003cem\u003eE. meningoseptica\u003c/em\u003e isolates were genetically homogeneous (2/7 strains were type A and 2/7 strains were type B) in the hematology and emergency ICU wards, suggesting recent clonal amplification and persistence between the wards. Previous reports have found that the acquisition of \u003cem\u003eElizabethkingia\u003c/em\u003e may be associated with water sources or water-related equipment, such as sinks and hand hygiene sink aerators in the hospital environment\u0026nbsp;(11, 29). Clonal transmission may be mediated by the hands of hospital staff or patients; therefore, there is a need for better hand hygiene and environmental cleanliness if an isolate is detected in hospitals\u0026nbsp;(15).\u003c/p\u003e\n\u003cp\u003eIt should be noted that this study has several limitations. (i) This is a single-center study with some bias in the data, and follow-up studies with larger and more extensive multicenter are needed. (ii) We have not made any further distinction between \u003cem\u003eElizabethkingia\u003c/em\u003e isolates by sequencing the 32rpoB gene and by sequencing the whole genome. (iii) No further exploration of biofilm formation was performed .\u003c/p\u003e"},{"header":"Conclusions","content":"\u003cp\u003e\u003cem\u003eElizabethkingia\u003c/em\u003e infection has become an important public health concern; therefore, it is crucial to understand its clinical, molecular, and genetic characteristics. In the present study, 16S rRNA gene sequencing was performed on 103 \u003cem\u003eElizabethkingia\u003c/em\u003e isolates. Microbiological characterization of the identified \u003cem\u003eElizabethkingia\u003c/em\u003e isolates revealed the resistance patterns and genetic diversity of the clinical isolates at this site. As much research and clinical practice continue to rely on automated bacteriological identification systems to characterize \u003cem\u003eElizabethkingia\u003c/em\u003e, upgrading MALDI-TOF mass spectrometry with expanded reference databases, or the use of molecular techniques, is necessary to accurately characterize these microorganisms. \u003cem\u003eElizabethkingia\u003c/em\u003e exhibits variable susceptibility to various antibiotics; therefore, if antimicrobial susceptibility testing is used as a guide, treatment will be more reliable. Our results show that minocycline has the potential to become the drug of choice for patients with \u003cem\u003eElizabethkingia\u003c/em\u003e infections; however, clinical trials are required. Further research is required to determine the optimal antimicrobial agents for these life-threatening infections, either alone or in combination.\u003c/p\u003e"},{"header":"Declarations","content":"\u003ch2\u003eData availability\u003c/h2\u003e\n\u003cp\u003eAll data generated or analyzed during this study are included in this published article and raw data will be available upon request. The sequences of detected genes were submitted to the GenBank database under accession numbers PQ057235-PQ057337\u003c/p\u003e\n\u003cp\u003eAcknowledgements\u003c/p\u003e\n\u003cp\u003eThe authors thank all the members in the laboratory.\u003c/p\u003e\n\u003cp\u003eFunding\u003c/p\u003e\n\u003cp\u003eThis research was funded by the National Natural Science Foundation of China (grant number 82102411, 82260403,32370195); the Clinical Research Nurture Project of the First Affiliated Hospital of Nanchang University (grant number YFYLCYJPY202201);\u0026nbsp;Science and Technology Program Project of the Health and Wellness Commission of Jiangxi Province(grant number 202130167).\u003c/p\u003e\n\u003cp\u003eAuthor information\u003c/p\u003e\n\u003cp\u003eXiuhua Kang and Huaming Guo\u0026nbsp;contributed equally.\u003c/p\u003e\n\u003cp\u003eAuthors and Affiliations\u003c/p\u003e\n\u003cp\u003e\u003csup\u003ea\u003c/sup\u003e Jiangxi Medical Center for Critical Public Health Events, The First Affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang 330052, China.\u003c/p\u003e\n\u003cp\u003e\u003csup\u003eb\u003c/sup\u003e Infection Control Division, the First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi 330006, P. R. China.\u003c/p\u003e\n\u003cp\u003e\u003csup\u003ec.\u003c/sup\u003eFirst Clinical Medical College, Nanchang University, Nanchang, China.\u003c/p\u003e\n\u003cp\u003e\u003csup\u003ed\u0026nbsp;\u003c/sup\u003eDepartment of Clinical Laboratory, The First Affiliated Hospital, Jiangxi Medical College, Nanchang University, 17 Yongwai Zhengjie, Nanchang 330006, China\u003c/p\u003e\n\u003cp\u003e\u003csup\u003ee\u003c/sup\u003e China-Japan Friendship Jiang Xi Hospital, National Regional Center for Respiratory Medicine, Nanchang 330006, Jiangxi, China\u003c/p\u003e\n\u003cp\u003eContributions\u003c/p\u003e\n\u003cp\u003eThe study was designed by DDW and YL, while HMG, STZ , PL, YFM and WZZ conducted the experiments. YL, HMG, LZ and XHK carried out the analysis, and HMG , XHK and DDW drafted the manuscript. All authors contributed to and approved the final version of the article\u0026nbsp;.\u003c/p\u003e\n\u003cp\u003eCorresponding author\u003c/p\u003e\n\u003cp\u003eCorrespondence to\u0026nbsp;Yang Liu or Dandan Wei\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthics declarations\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eEthics approval and consent to participate\u003c/p\u003e\n\u003cp\u003eBased on the rules of the Ethical Committee of our institute, this study did not require informed consent statement, because all isolates were recovered from clinical specimens during routine diagnostic procedures and these isolates were not specific to this study. In addition, the patients were not available to us. Based on the points mentioned above, the Ethics Committee of the First Affiliated Hospital of Nanchang University approved our project and allowed this study to be conducted without informed consent statement.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eConsent for publication\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003eCompeting interests\u003c/p\u003e\n\u003cp\u003eThe authors declare that they have no competing interest.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eComba IY, Schuetz AN, Misra A, Friedman DZP, Stevens R, Patel R, et al. Antimicrobial Susceptibility of Elizabethkingia Species: Report from a Reference Laboratory. Journal of Clinical Microbiology. 2022;60(6):e0254121.\u003c/li\u003e\n\u003cli\u003eLin J-N, Lai C-H, Yang C-H, Huang Y-H. Elizabethkingia Infections in Humans: From Genomics to Clinics. Microorganisms. 2019;7(9):295.\u003c/li\u003e\n\u003cli\u003eKing EO. 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Int J Syst Evol Microbiol. 2011;61(Pt 11):2670-5.\u003c/li\u003e\n\u003cli\u003eLin IF, Lai CH, Lin SY, Lee CC, Lee NY, Liu PY, et al. In Vitro and In Vivo Antimicrobial Activities of Vancomycin and Rifampin against Elizabethkingia anophelis. Int J Mol Sci. 2023;24(23).\u003c/li\u003e\n\u003cli\u003eTeo J, Tan SY, Tay M, Ding Y, Kjelleberg S, Givskov M, et al. First case of E anophelis outbreak in an intensive-care unit. Lancet. 2013;382(9895):855-6.\u003c/li\u003e\n\u003cli\u003eNicholson AC, Gulvik CA, Whitney AM, Humrighouse BW, Graziano J, Emery B, et al. Revisiting the taxonomy of the genus Elizabethkingia using whole-genome sequencing, optical mapping, and MALDI-TOF, along with proposal of three novel Elizabethkingia species: Elizabethkingia bruuniana sp. nov., Elizabethkingia ursingii sp. nov., and Elizabethkingia occulta sp. nov. Antonie Van Leeuwenhoek. 2018;111(1):55-72.\u003c/li\u003e\n\u003cli\u003eHoque SN, Graham J, Kaufmann ME, Tabaqchali S. Chryseobacterium (Flavobacterium) meningosepticum outbreak associated with colonization of water taps in a neonatal intensive care unit. J Hosp Infect. 2001;47(3):188-92.\u003c/li\u003e\n\u003cli\u003eLee YL, Liu KM, Chang HL, Lin JS, Kung FY, Ho CM, et al. A dominant strain of Elizabethkingia anophelis emerged from a hospital water system to cause a three-year outbreak in a respiratory care center. J Hosp Infect. 2021;108:43-51.\u003c/li\u003e\n\u003cli\u003eCeyhan M, Yildirim I, Tekeli A, Yurdakok M, Us E, Altun B, et al. A Chryseobacterium meningosepticum outbreak observed in 3 clusters involving both neonatal and non-neonatal pediatric patients. Am J Infect Control. 2008;36(6):453-7.\u003c/li\u003e\n\u003cli\u003eJohnson WL, Gupta SK, Maharjan S, Morgenstein RM, Nicholson AC, McQuiston JR, et al. A Genetic Locus in Elizabethkingia anophelis Associated with Elevated Vancomycin Resistance and Multiple Antibiotic Reduced Susceptibility. Antibiotics (Basel). 2024;13(1).\u003c/li\u003e\n\u003cli\u003eKyritsi MA, Mouchtouri VA, Pournaras S, Hadjichristodoulou C. First reported isolation of an emerging opportunistic pathogen (Elizabethkingia anophelis) from hospital water systems in Greece. J Water Health. 2018;16(1):164-70.\u003c/li\u003e\n\u003cli\u003eChew KL, Cheng B, Lin RTP, Teo JWP. Elizabethkingia anophelis Is the Dominant Elizabethkingia Species Found in Blood Cultures in Singapore. J Clin Microbiol. 2018;56(3).\u003c/li\u003e\n\u003cli\u003eLin JN, Lai CH, Yang CH, Huang YH. Elizabethkingia Infections in Humans: From Genomics to Clinics. Microorganisms. 2019;7(9).\u003c/li\u003e\n\u003cli\u003eWu C, Xiong L, Liao Q, Zhang W, Xiao Y, Xie Y. Clinical manifestations, antimicrobial resistance and genomic feature analysis of multidrug-resistant Elizabethkingia strains. Ann Clin Microbiol Antimicrob. 2024;23(1):32.\u003c/li\u003e\n\u003cli\u003ePuah SM, Fong SP, Kee BP, Puthucheary SD, Chua KH. 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Elizabethkingia anophelis bacteremia is associated with clinically significant infections and high mortality. Sci Rep. 2016;6:26045.\u003c/li\u003e\n\u003cli\u003eReed TAN, Watson G, Kheng C, Tan P, Roberts T, Ling CL, et al. Elizabethkingia anophelis Infection in Infants, Cambodia, 2012-2018. Emerg Infect Dis. 2020;26(2):320-2.\u003c/li\u003e\n\u003cli\u003eSarathi S, Behera B, Mahapatra A, Mohapatra S, Jena J, Nayak S. Microbiological Characterization and Clinical Facets of Elizabethkingia Bloodstream Infections in a Tertiary Care Hospital of Eastern India. Infect Drug Resist. 2023;16:3257-67.\u003c/li\u003e\n\u003cli\u003eKo HK, Yu WK, Lien TC, Wang JH, Slutsky AS, Zhang H, et al. Intensive care unit-acquired bacteremia in mechanically ventilated patients: clinical features and outcomes. PLoS One. 2013;8(12):e83298.\u003c/li\u003e\n\u003cli\u003eHuang YC, Huang YW, Lin YT, Wang FD, Chan YJ, Yang TC. Risk factors and outcome of levofloxacin-resistant Elizabethkingia meningoseptica bacteraemia in adult patients in Taiwan. Eur J Clin Microbiol Infect Dis. 2017;36(8):1373-80.\u003c/li\u003e\n\u003cli\u003eBurnard D, Gore L, Henderson A, Ranasinghe A, Bergh H, Cottrell K, et al. Comparative Genomics and Antimicrobial Resistance Profiling of Elizabethkingia Isolates Reveal Nosocomial Transmission and In Vitro Susceptibility to Fluoroquinolones, Tetracyclines, and Trimethoprim-Sulfamethoxazole. J Clin Microbiol. 2020;58(9).\u003c/li\u003e\n\u003cli\u003eSeong H, Kim JH, Kim JH, Lee WJ, Ahn JY, M DN, et al. Risk Factors for Mortality in Patients with Elizabethkingia Infection and the Clinical Impact of the Antimicrobial Susceptibility Patterns of Elizabethkingia Species. J Clin Med. 2020;9(5).\u003c/li\u003e\n\u003cli\u003eChoi MH, Kim M, Jeong SJ, Choi JY, Lee IY, Yong TS, et al. Risk Factors for Elizabethkingia Acquisition and Clinical Characteristics of Patients, South Korea. Emerg Infect Dis. 2019;25(1):42-51.\u003c/li\u003e\n\u003cli\u003eJiang X, Wang D, Wang Y, Yan H, Shi L, Zhou L. Occurrence of antimicrobial resistance genes sul and dfrA12 in hospital environmental isolates of Elizabethkingia meningoseptica. World J Microbiol Biotechnol. 2012;28(11):3097-102.\u003c/li\u003e\n\u003cli\u003eSpengler G, Kincses A, Gajd\u0026aacute;cs M, Amaral L. New Roads Leading to Old Destinations: Efflux Pumps as Targets to Reverse Multidrug Resistance in Bacteria. Molecules. 2017;22(3).\u003c/li\u003e\n\u003cli\u003eAgrawal A, Ravikumar R, Varun CN, Kumar M, Chatterjee O, Advani J, et al. Global Proteome Profiling Reveals Drug-Resistant Traits in Elizabethkingia meningoseptica: An Opportunistic Nosocomial Pathogen. Omics. 2019;23(6):318-26.\u003c/li\u003e\n\u003cli\u003eChang TY, Chen HY, Chou YC, Cheng YH, Sun JR. In vitro activities of imipenem, vancomycin, and rifampicin against clinical Elizabethkingia species producing BlaB and GOB metallo-beta-lactamases. Eur J Clin Microbiol Infect Dis. 2019;38(11):2045-52.\u003c/li\u003e\n\u003cli\u003eChang YC, Lo HH, Hsieh HY, Chang SM. Identification and epidemiological relatedness of clinical Elizabethkingia meningoseptica isolates from central Taiwan. J Microbiol Immunol Infect. 2014;47(4):318-23.\u003c/li\u003e\n\u003cli\u003eLin JN, Lai CH, Yang CH, Huang YH. Correction: Jiun-Nong Lin; Chung-Hsu Lai; Chih-Hui Yang and Yi-Han Huang. Comparison of Clinical Manifestations, Antimicrobial Susceptibility Patterns, and Mutations of Fluoroquinolone Target Genes between Elizabethkingia meningoseptica and Elizabethkingia anophelis Isolated in Taiwan. Journal of Clinical Medicine 2018, 7, 538. J Clin Med. 2019;8(4).\u003c/li\u003e\n\u003cli\u003eCheng J, Zhao D, Ma X, Li J. Molecular epidemiology, risk factors, and outcomes of carbapenem-resistant Klebsiella pneumoniae infection in a tertiary hospital in eastern China: for a retrospective study conducted over 4 years. Frontiers in Microbiology. 2023;14.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-microbiology","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"mcro","sideBox":"Learn more about [BMC Microbiology](http://bmcmicrobiol.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/mcro","title":"BMC Microbiology","twitterHandle":"#bmcmicrobiology","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"","lastPublishedDoi":"10.21203/rs.3.rs-4674119/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-4674119/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003eBackground\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eElizabethkingia\u003c/em\u003e infections have gradually become life-threatening hospital-acquired infections worldwide with increasing morbidity, multidrug resistance, and poor prognosis. However, information on the epidemiological and clinical characteristics of \u003cem\u003eElizabethkingia\u003c/em\u003e infections in mainland China is limited. The aim of this study was to analyze the molecular and clinical characteristics, and drug susceptibility of clinical \u003cem\u003eElizabethkingia\u003c/em\u003e isolates from a hospital in Jiangxi Province, China.\u003c/p\u003e\n\u003cp\u003eResults\u003c/p\u003e\n\u003cp\u003eThe mean age of the patients was 61 years (excluding one 13-day-old infant) and 74.8% were male. In total, 85.4% of patients admitted to Intensive Care Unit were infected with \u003cem\u003eElizabethkingia\u003c/em\u003e. COVID-19, respiratory disease, and central venous catheterization rates were significantly different (\u003cem\u003eP \u003c/em\u003e\u0026lt;0.05) between the surviving and dying groups. Sequencing of 103 isolates identified 92 strains of \u003cem\u003eElizabethkingia anopheles\u003c/em\u003e, eight strains of \u003cem\u003eElizabethkingia meningoseptica,\u003c/em\u003e two strains of \u003cem\u003eElizabethkingia bruuniana\u003c/em\u003e, and one strain of \u003cem\u003eElizabethkingia ursingii.\u003c/em\u003e The Vitek MS had a correct identification rate of 87% for \u003cem\u003eE. anopheles\u003c/em\u003e. More than 90% of the \u003cem\u003eElizabethkingia \u003c/em\u003eisolates were susceptible to minocycline, but resistant to other drugs, including ceftazidime, aztreonam, and imipenem. Resistance genotype analysis showed that \u003cem\u003eblaBlaB\u003c/em\u003e and \u003cem\u003eblaCME\u003c/em\u003e were highly prevalent in the \u003cem\u003eElizabethkingia\u003c/em\u003e isolates. Molecular typing revealed 29 different PFGE types with clonal transmission between wards.\u003c/p\u003e\n\u003cp\u003eConclusions\u003c/p\u003e\n\u003cp\u003eMultidrug-resistant \u003cem\u003eElizabethkingia\u003c/em\u003eare beingdetected at increasing rates; a larger database is required for strain identification of this bacterium. This database could be beneficial for the subsequent determination of optimal antimicrobial drugs for the treatment of infections caused by different \u003cem\u003eElizabethkingia\u003c/em\u003e strains. Our PFGE model showed that most isolates had sufficient genetic diversity and clonal transmission; adequate attention should be paid to this pathogen.\u003c/p\u003e","manuscriptTitle":"Prevalence, and Microbiological and Clinical Characteristics of Elizabethkingia Isolates from a tertiary hospital in Jiangxi Province, China","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-09-02 19:25:07","doi":"10.21203/rs.3.rs-4674119/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2024-09-17T10:15:43+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2024-09-14T03:26:32+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"140266340209611928378977167543994036644","date":"2024-09-13T14:06:34+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2024-08-10T07:36:43+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"173511982469209520610224659568449829903","date":"2024-08-06T01:59:39+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2024-08-05T18:47:01+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2024-07-31T14:42:46+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2024-07-30T14:04:32+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2024-07-30T14:04:19+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Microbiology","date":"2024-07-02T12:12:20+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-microbiology","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"mcro","sideBox":"Learn more about [BMC Microbiology](http://bmcmicrobiol.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/mcro","title":"BMC Microbiology","twitterHandle":"#bmcmicrobiology","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"147c71e9-eedd-4baa-a710-d85569d3f271","owner":[],"postedDate":"September 2nd, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2024-10-02T03:38:13+00:00","versionOfRecord":[],"versionCreatedAt":"2024-09-02 19:25:07","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-4674119","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-4674119","identity":"rs-4674119","version":["v1"]},"buildId":"qtupq5eGEP_6zYnWcrvyt","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}