Clinical and molecular characteristics of Chryseobacterium indologenes isolates at a teaching hospital in Shanghai, China

Background: Chryseobacterium indologenes (C. indologenes) has recently emerged as a cause of life-threatening nosocomial infections in humans. This study aims to investigate the clinical characteristics, homology, and antimicrobial patterns of C. indologenes clinical isolates at a teaching hospital in Shanghai, China. Methods: A total of 135 consecutive non-replicate clinical C. indologenes isolates from January 2010 to December 2018 were collected at a tertiary care university hospital in Shanghai, China. Genetic relatedness of the isolates was performed by pulsed-field gel electrophoresis (PFGE). The antimicrobial susceptibility of these isolates was measured by the microdilution broth method. The prevalence of beta-lactamase genes was investigated by polymerase chain reaction (PCR), while the quinolone resistance-determining regions (QRDRs) were sequenced. Results: All 135 C. indologenes isolates were collected from hospitalized patients with an average age of 55 years. Most of these clinical isolates were derived from ascites (59.3%) or urine (23.7%) specimens. Eighty (80/135) of the strains were classified as clone D by PFGE. In vitro drug susceptibility tests showed that minocycline and trimethoprim-sulfamethoxazole had sound antibacterial effects. However, more than 86% of the tested strains were resistant to cephalosporins (ceftazidime, cefotaxime), beta-lactamase/beta-lactamase inhibitors (cefoperazone-sulbactam), and carbapenems (meropenem, imipenem). Metallo-beta-lactamase bla(IND) and type A broad-spectrum beta-lactamase genes bla(CIA) were present in 135 and 103 isolates, respectively. The clinical strains in our hospital mainly carried bla(IND-2) (89.6%, 121/135). Compared with previous studies, these strains had a high rate of resistance to quinolones. The resistance rates to levofloxacin, ciprofloxacin, norfloxacin, gatifloxacin, and nemonoxacin were as high as 83.7-94.8%. The mutations at Ser83Val, Ser83Tyr, and Asp87Gly in the QRDRs of GyrA were significantly related to the resistance of C. indologenes to levofloxacin. All but one quinolone-resistant strain contained at least one significant mutation. Conclusions: This study showed a clonal dissemination of C. indologenes isolates in infections at a tertiary care university hospital in Shanghai, China. Minocycline and trimethoprim-sulfamethoxazole had favorable in vitro antibacterial effects. However, the high resistance rate to beta-lactams and quinolones was due to carrying beta-lactamase (bla(IND), bla(CIA)), and mutations in the QRDRs of GyrA.

Automated summary

This study revealed a clonal dissemination of C. indologenes isolates in infections at a tertiary care university hospital in Shanghai, China. Minocycline and trimethoprim-sulfamethoxazole demonstrated favorable in vitro antibacterial effects. However, high resistance rates to beta-lactams and quinolones were primarily due to the presence of beta-lactamase genes (bla(IND), bla(CIA)) and mutations in the QRDRs of GyrA.