Abstract
The clinical importance of Enterobacter spp. remains unclear because phenotype-based Enterobacter species identification is unreliable. We performed a genomic study on 48 cases of Enterobacter-caused bloodstream infection by using in silico DNA–DNA hybridization to identify precise species. Strains belonged to 12 species; Enterobacter xiangfangensis (n = 21) and an unnamed species (taxon 1, n = 8) were dominant. Most (63.5%) Enterobacter strains (n = 349) with genomes in GenBank from human blood are E. xiangfangensis; taxon 1 (19.8%) was next most common. E. xiangfangensis and taxon 1 were associated with increased deaths (20.7% vs. 15.8%), lengthier hospitalizations (median 31 d vs. 19.5 d), and higher resistance to aztreonam, cefepime, ceftriaxone, piperacillin-tazobactam, and tobramycin. Strains belonged to 37 sequence types (STs); ST171 (E. xiangfangensis) was most common (n = 6). Four ST171 strains belonged to a defined clone. Precise species identification has greater implications for epidemiology and infection control than treatment.
Highlights
The clinical importance of Enterobacter spp. remains unclear because phenotype-based Enterobacter species identification is unreliable
The remaining strains were assigned to 10 Enterobacter species: E. bugandensis (n = 4), E. cloacae (n = 3), E. asburiae (n = 2), E. hormaechei (n = 2), E. huaxiensis (n = 2), E. roggenkampii (n = 2), E. chuandaensis (n = 1), E. ludwigii (n = 1), E. sichuanensis (n = 1), and an unnamed Enterobacter sp. (n = 1) (Table 2)
Genome sequences deposited in GenBank might be biased in sampling, they can provide complementary information on the species distribution of Enterobacter in cases of bloodstream infection (BSI)
Summary
The clinical importance of Enterobacter spp. remains unclear because phenotype-based Enterobacter species identification is unreliable. We performed a genomic study on 48 cases of Enterobacter-caused bloodstream infection by using in silico DNA–DNA hybridization to identify precise species. Strains belonged to 12 species; Enterobacter xiangfangensis (n = 21) and an unnamed species (taxon 1, n = 8) were dominant. E nterobacter spp. belongs to the family Enterobacteriaceae and is a common pathogen in a variety of infections, such as bloodstream and intraabdominal infections, most of which are healthcare associated [1]. Enterobacter spp. is the third most common human pathogen, after Escherichia coli and Klebsiella pneumoniae, and is of clinical importance [1]. Enterobacter consists of several closely related species [1] that cannot typically be identified precisely by common phenotypic tests. With validly published names exist, and 3 additional Enterobacter spp. have tentative species designations awaiting validation under the rules of the International Code of Nomenclature of Bacteria (Bacteriological Code)
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