Orthopedic infections associated with distinct strains in rural area of Qingdao, China.

INTRODUCTION

poses a profound global health threat because of multidrug resistance and its association with nosocomial infections. However, standard clinical diagnostics often report it together with other species as complex (ABC), which unavoidably conceals the attribution of non- species. This study reported orthopedic infection cases associated with different species and characterized the genomes of the culture isolates to evaluate their potential impact on the clinical treatment.

METHODS

Nine in-patients with complex identified by culture during hospitalization were enrolled by the Orthopedics Department from a local hospital in Qingdao, China. Their clinical data were reviewed. One ABC isolate from each patient was tested for drug susceptibility and subjected for whole-genome sequencing, followed by bioinformatic analyses.

RESULTS

Through whole-genome analysis, nine ABC isolates were identified as six , two , and one with distinct antibiotic resistance profiles and phylogenetic characteristics, indicating progressing pathogen transmission across broad geographic regions in One Health perspective. All and strains carried multidrug resistance genes, while bore only and . Phenotypically, eight isolates were susceptible to almost all the antibiotics tested, with only one being multidrug resistant. Despite this, eight patients received cephalosporins following positive reports of complex.

CONCLUSION

Our study highlighted the limitation of current clinical diagnostic approaches for non- cases, which tended to be overtreated, and suggested that etiology landscape should be explored further beyond to avoid antibiotic misuse.