Intra-Abdominal Infection and Related Trimethoprim-Sulfamethoxazole Resistance: A Clinical-Genomic Study.

(1) : spp. is an emerging nosocomial pathogen which causes mostly blood stream infection and nosocomial pneumonia. Among species, is the major pathogen, but misidentification as is a common problem. also possesses broad antibiotic resistance, resulting in high morbidity and mortality of the infection. The aim of our study was to review intra-abdominal infections and investigate resistance mechanisms against TMP/SMX in by whole genome sequencing. (2) : We retrospectively searched records of patients with intra-abdominal infection between 1990 and 2019. We also conducted whole genome sequencing for a TMP/SMX-resistant to identify possible mechanisms of resistance. (3) : We identified a total of nine cases of intra-abdominal infection in a review of the literature, including our own case. The cases included three biliary tract infections, three CAPD-related infection, two with infected ascites, and two postoperation infections. Host factor, indwelling-catheter, and previous invasive procedure, including surgery, play important roles in infection. Removal of the catheter is crucial for successful treatment. Genomic analysis revealed accumulated mutations leading to TMP/SMX-resistance in . (4) : Patients with underlying disease and indwelling catheter are more susceptible to intra-abdominal infection, and successful treatment requires removal of the catheter. The emerging resistance to TMP/SMX may be related to accumulated mutations in .