title: Distribution, virulence-associated genes and antimicrobial resistance of Aeromonas isolates from diarrheal patients and water, China.
abstract: OBJECTIVE
  To determine the prevalence of Aeromonas infections in diarrheal patients, the distribution of virulence-associated genes and antibiotic resistance among different Aeromonas species in China.
  
  
  METHODS
  We conducted continual active surveillance aimed on Aeromonas from diarrheal patients and aquatic samples. Aeromonas strains were identified by biochemical tests, further confirmed to species level by a multilocus phylogenetic analysis. Potential virulence genes were detected by PCR. Antibiotics susceptibility testing was carried based on the minimal inhibitory concentration.
  
  
  RESULTS
  From 5069 samples (stool specimens, n = 4529; water samples, n = 540) in China, 257 Aeromonas isolates [stools, n = 193 (4.3%); water, n = 64 (11.9%)] were identified by biochemical tests. The most common species from stools and water were Aeromonas veronii (42.5%) and Aeromonas caviae (37.5%), respectively. Distribution of five potential genes were significantly different between stool and water samples, two genes (ast and alt) were higher in stool than in water samples (P < 0.01). Meanwhile, three species (A. veronii, A. caviae and Aeromonas aquariorum) account for the six most prevalent combination patterns of potential genes. Furthermore, strains resistant to nine antibiotics was markedly higher in strains isolated from water than those from stools (P ≤ 0.003); in contrast, resistance to only two antibiotics was higher in strains isolated from stools compared to those from water. In addition, strains containing multiple antibiotic resistance (MAR) from stools (8.6%; 16/187) and water (30.2%; 19/63) were resistant to ten or more antibiotics.
  
  
  CONCLUSIONS
  Our study highlights the multiple factors involved in the pathogenesis of Aeromonas and reveals that environmental Aeromonas has acquired a wide range of MAR compared to those from clinical sources.
authors.affiliation: National Institute for Communicable Disease Control and Prevention, China CDC /State Key Laboratory for Infectious Disease Prevention and Control, Beijing, China; Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, Hangzhou, China.
authors.forename: Fengjuan
authors.initials: F
authors.lastname: Li
authors.affiliation: CDC of Pudong New Area, Shanghai, China.
authors.forename: Wenqing
authors.initials: W
authors.lastname: Wang
authors.affiliation: Shanghai Public Health Clinical Center, Fudan University, Shanghai, China.
authors.forename: Zhaoqin
authors.initials: Z
authors.lastname: Zhu
authors.affiliation: CDC of Fujian Province, Fuzhou, China.
authors.forename: Aiping
authors.initials: A
authors.lastname: Chen
authors.affiliation: National Institute for Communicable Disease Control and Prevention, China CDC /State Key Laboratory for Infectious Disease Prevention and Control, Beijing, China; Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, Hangzhou, China.
authors.forename: Pengcheng
authors.initials: P
authors.lastname: Du
authors.affiliation: National Institute for Communicable Disease Control and Prevention, China CDC /State Key Laboratory for Infectious Disease Prevention and Control, Beijing, China; Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, Hangzhou, China.
authors.forename: Ruibai
authors.initials: R
authors.lastname: Wang
authors.affiliation: Shanghai Public Health Clinical Center, Fudan University, Shanghai, China.
authors.forename: Haili
authors.initials: H
authors.lastname: Chen
authors.affiliation: Shanghai Public Health Clinical Center, Fudan University, Shanghai, China.
authors.forename: Yunwen
authors.initials: Y
authors.lastname: Hu
authors.affiliation: National Institute for Communicable Disease Control and Prevention, China CDC /State Key Laboratory for Infectious Disease Prevention and Control, Beijing, China; Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, Hangzhou, China.
authors.forename: Jie
authors.initials: J
authors.lastname: Li
authors.affiliation: National Institute for Communicable Disease Control and Prevention, China CDC /State Key Laboratory for Infectious Disease Prevention and Control, Beijing, China; Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, Hangzhou, China. Electronic address: kanbiao@icdc.cn.
authors.forename: Biao
authors.initials: B
authors.lastname: Kan
authors.affiliation: National Institute for Communicable Disease Control and Prevention, China CDC /State Key Laboratory for Infectious Disease Prevention and Control, Beijing, China; Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, Hangzhou, China. Electronic address: wangduochun@icdc.cn.
authors.forename: Duochun
authors.initials: D
authors.lastname: Wang
mesh_terms: D000293:Adolescent; D000328:Adult; D000333:Aeromonas / Q000187:drug effects / Q000235:genetics / Q000302:isolation & purification* / Q000472:pathogenicity; D000368:Aged; D000369:Aged, 80 and over; D000890:Anti-Infective Agents / Q000494:pharmacology*; D001426:Bacterial Proteins / Q000235:genetics; D002648:Child; D002675:Child, Preschool; D002681:China / Q000453:epidemiology; D060085:Coinfection; D003967:Diarrhea / Q000382:microbiology; D024881:Drug Resistance, Bacterial; D005243:Feces / Q000382:microbiology; D016905:Gram-Negative Bacterial Infections / Q000453:epidemiology* / Q000382:microbiology; D006801:Humans; D007223:Infant; D008875:Middle Aged; D010802:Phylogeny; D017422:Sequence Analysis, DNA; D014774:Virulence; D037521:Virulence Factors / Q000235:genetics*; D014871:Water Microbiology; D055815:Young Adult
chemical_list: D000890:Anti-Infective Agents; D001426:Bacterial Proteins; D037521:Virulence Factors
keywords: Aeromonas isolates; Antimicrobial resistance; China; Distribution; Virulence-associated genes