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Objectives  Several  Elizabethkingia  species often exhibit extensive antibiotic resistance, causing infections associated with severe morbidity and high mortality rates worldwide. In this study, we determined fluoroquinolone susceptibility profiles of clinical  Elizabethkingia  spp. isolates and investigated the resistance mechanisms.    Methods  In 2017–2018, 131  Elizabethkingia  spp. isolates were recovered from specimens collected at tertiary care centers in northern Taiwan. Initial species identification using the Vitek MS system and subsequent verification by 16S rRNA sequencing confirmed the presence of  Elizabethkingia anophelis  ( n  = 111),  E. miricola  ( n  = 11), and  E. meningoseptica  ( n  = 9). Fluoroquinolone susceptibility was determined using the microbroth dilution method, and fluoroquinolone resistance genes were analyzed by sequencing.    Results  Among  Elizabethkingia  spp. isolates, 91% and 77% were resistant to ciprofloxacin and levofloxacin, respectively. The most prevalent alterations were two single mutations in GyrA, Ser83Ile, and Ser83Arg, detected in 76% of the isolates exhibiting fluoroquinolone MIC between 8 and 128 μg/ml. Another GyrA single mutation, Asp87Asn, was identified in two quinolone-resistant  E. miricola  strains. None of the isolates had alterations in GyrB, ParC, or ParE. We developed a high-resolution melting assay for rapid identification of the prevalent  gyrA  gene mutations. The genetic relationship between the isolates was evaluated by random amplified polymorphic DNA PCR that yielded diverse pulsotypes, indicating the absence of any temporal or spatial overlap among the patients during hospitalization.    Conclusion  Our analysis of fluoroquinolone-resistant  Elizabethkingia  spp. isolates provides information for further research on the variations of the resistance mechanism and potential clinical guidance for infection management.

Molecular typing and profiling of topoisomerase mutations causing resistance to ciprofloxacin and levofloxacin inElizabethkingiaspecies