Elizabethkingia species are environmental bacteria associated with opportunistic infections in vulnerable populations. Traditionally, Elizabethkingia meningoseptica was considered the predominant pathogenic species. However, commercial identification systems have routinely misidentified Elizabethkingia anophelis as E. meningoseptica, leading to a mischaracterization of clinical strains and an underestimation of the role of E. anophelis in human disease. Elizabethkingia spp. harbor multidrug resistance (MDR) genes that pose challenges for treatment. Differentiation between Elizabethkingia spp. is particularly important due to differences in antimicrobial resistance (AMR) and epidemiological investigation. In this study, we describe a case of MDR E. anophelis isolated from the blood and lower respiratory tract of a patient who was successfully treated with minocycline. These isolates were initially misidentified by matrix assisted laser desorption ionization-time of flight as E. meningoseptica, whereas whole genome sequencing (WGS) confirmed the isolates as E. anophelis with the closest related strain being E. anophelis NUHP1, which was implicated in a 2012 outbreak in Singapore. Several AMR genes (blaBlaB, blaBlaGOB, blaCME, Sul2, erm(F), and catB) were identified by WGS, confirming the mechanisms for MDR. This case emphasizes the utility of WGS for correct speciation, elucidation of resistance genes, and relatedness to other outbreak strains. As E. anophelis is associated with a high mortality and has been found in hospital system sinks, WGS is critically important for determining strain relatedness and tracking outbreaks in the hospital setting.

中文翻译：

---

血液及下呼吸道分离伊丽莎白王按蚊系统发育及耐药机制研究

Elizabethkingia物种是与易感人群中的机会性感染相关的环境细菌。传统上，Elizabethkingia meningoseptica被认为是主要的致病物种。然而，商业鉴定系统经常将Elizabethkingia anophelis误认为是脑膜炎双球菌，导致临床菌株的错误表征和对按蚊在人类疾病中的作用的低估。Elizabethkingia spp。含有对治疗构成挑战的多药耐药 (MDR) 基因。Elizabethkingia之间的区别spp. 由于抗菌素耐药性 (AMR) 和流行病学调查的差异，这一点尤为重要。在这项研究中，我们描述了一例从一名成功使用米诺环素治疗的患者的血液和下呼吸道中分离出的耐多药按蚊。这些分离株最初被基质辅助激光解吸电离飞行时间错误识别为脑膜炎奈瑟菌，而全基因组测序 (WGS) 证实分离株为按蚊，最接近的相关菌株为按蚊NUHP1，它与 2012 年新加坡爆发的疫情有关。WGS 鉴定了几个 AMR 基因（blaBlaB、blaBlaGOB、blaCME、Sul2、erm(F) 和 catB），证实了 MDR 的机制。该案例强调了 WGS 在正确物种形成、阐明抗性基因以及与其他暴发菌株的相关性方面的效用。由于按蚊与高死亡率相关并且已在医院系统的水槽中发现，WGS 对于确定菌株相关性和跟踪医院环境中的爆发至关重要。