Abstract
We appreciate the constructive feedback from Rahim et al. [[1]Rahim G.R. Gupta N. Maheshwari P. Re: ‘Multicentre study evaluating matrix-assisted laser desorption ionization-time of flight mass spectrometry for identification of clinically isolated Elizabethkingia species and analysis of antimicrobial susceptibility’ by Shang et al..Clin Microbiol Infect. 2019; 25: 386-387Abstract Full Text Full Text PDF PubMed Scopus (2) Google Scholar] and are grateful for the opportunity to reply. Our responses to the comments are as follows. Firstly, it is true that Elizabethkingia species could be distinguished ambiguously by phenotypic differences because biochemical reactions of various species are similar according to Supplemental Table 3 in the study of Nicholson et al. [[2]Nicholson A.C. Gulvik C.A. Whitney A.M. Humrighouse B.W. 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 Leeuwenhoek. 2018; 111: 55-72PubMed Google Scholar]. If biochemically based methods were to be used routinely in clinical microbiology, physicians would only observe the presence of Elizabethkingia meningosepticum in laboratory reports. Secondly, we agree that there are some misidentified strains in GenBank and researchers need to scrutinize them. Third, efficient and accurate identification of these pathogens has become possible owing to the implementation of MALDI-TOF in clinical microbiology. Nevertheless, Elizabethkingia could not be correctly distinguished initially. This could be due to the time of revisiting of the Elizabethkingia [[3]Kämpfer P. Matthews H. Glaeser S.P. 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: 2670-2675Crossref PubMed Scopus (123) Google Scholar] coinciding with the increasing usage of MALDI-TOF in clinical microbiology [[4]Bizzini A. Greub G. Matrix-assisted laser desorption ionization time-of-flight mass spectrometry, a revolution in clinical microbial identification.Clin Microbiol Infect. 2010; 16: 1614-1619Abstract Full Text Full Text PDF PubMed Scopus (353) Google Scholar]. However, it has been recently discovered that E. meningosepticum could be distinguished from E. anophelis and E. miricola by MALDI-TOF. In addition to Bruker, the latest version of the Vitek MS IVD database (IVD V3.2) was released by bioMérieux in May 2018. The database includes spectra for E. anophelis, E. miricola, and E. meningosepticum, and will be helpful for the identification of these species in clinical microbiology laboratories using Vitek MS systems. However, the new version of the database still requires validation. Finally, we concur with the suggestions for peer reviewers and journal editors in which some publications on E. meningosepticum could not confirm the species by 16S rRNA gene sequencing or whole genome sequencing [[5]Tai I.C. Liu T.P. Chen Y.J. Lien R.I. Lee C.Y. Huang Y.C. Outbreak of Elizabethkingia meningoseptica sepsis with meningitis in a well-baby nursery.J Hosp Infect. 2017; 96: 168-171Abstract Full Text Full Text PDF PubMed Scopus (19) Google Scholar]. Additionally, in view of numerous case reports that using biochemically based methods or MALDI-TOF with obsolete database, clinicians need to understand the new taxonomy of Elizabethkingia. Moreover, populations resistant to antibiotics, particularly fluoroquinolones and tigecycline, are related to different Elizabethkingia species. Further investigation into mechanisms of antimicrobial resistance could allow researchers and clinicians gain a better understanding of the usage of drugs on Elizabethkingia species [[6]Jian M.J. Cheng Y.H. Perng C.L. Shang H.S. Molecular typing and profiling of topoisomerase mutations causing resistance to ciprofloxacin and levofloxacin in Elizabethkingia species.PeerJ. 2018; 6e5608Crossref PubMed Scopus (9) Google Scholar]. None of the authors have any conflict of interest to declare. Multicentre study evaluating matrix-assisted laser desorption ionization–time of flight mass spectrometry for identification of clinically isolated Elizabethkingia species and analysis of antimicrobial susceptibilityClinical Microbiology and InfectionVol. 25Issue 3PreviewRapid identification of Elizabethkingia species is essential because these species show variations in antibiotic susceptibility and clinical outcomes. Many recent inaccuracies in Elizabethkingia identification by matrix-assisted laser desorption ionization–time of flight mass spectrometry (MALDI-TOF MS) have been noted. Accordingly, in this study, we evaluated the use of MALDI-TOF MS with an amended database to identify isolates of Elizabethkingia anophelis, E. miricola and E. meningoseptica. We then investigated the antimicrobial susceptibility of Elizabethkingia. Full-Text PDF Open ArchiveRe: ‘Multicentre study evaluating matrix-assisted laser desorption ionization-time of flight mass spectrometry for identification of clinically isolated Elizabethkingia species and analysis of antimicrobial susceptibility’ by Shang et al.Clinical Microbiology and InfectionVol. 25Issue 3PreviewWe read with interest the article by Cheng et al. [1]. This work with regard to the identification of Elizabethkingia species has come at a time when there is a gradual rise in the reporting of Elizabethkingia cases and outbreaks in journals from various parts of the world. We would like to add a few comments to this article. Full-Text PDF Open Archive
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