Epidemiology and Characteristics of Elizabethkingia spp. Infections in Southeast Asia

Abstract

Elizabethkingia spp. is a ubiquitous pathogenic bacterium that has been identified as the causal agent for a variety of conditions such as meningitis, pneumonia, necrotizing fasciitis, endophthalmitis, and sepsis and is emerging as a global threat including in Southeast Asia. Elizabethkingia infections tend to be associated with high mortality rates (18.2–41%) and are mostly observed in neonates and immunocompromised patients. Difficulties in precisely identifying Elizabethkingia at the species level by traditional methods have hampered our understanding of this genus in human infections. In Southeast Asian countries, hospital outbreaks have usually been ascribed to E. meningoseptica, whereas in Singapore, E. anophelis was reported as the main Elizabethkingia spp. associated with hospital settings. Misidentification of Elizabethkingia spp. could, however, underestimate the number of cases attributed to the bacterium, as precise identification requires tools such as MALDI-TOF MS, and particularly whole-genome sequencing, which are not available in most hospital laboratories. Elizabethkingia spp. has an unusual antibiotic resistance pattern for a Gram-negative bacterium with a limited number of horizontal gene transfers, which suggests an intrinsic origin for its multidrug resistance. Efforts to prevent and further understand Elizabethkingia spp. infections and limit its spread must rise to this new challenge.

Epidemiological, clinical, and laboratory features of patients infected with Elizabethkingia meningoseptica at a tertiary hospital in Hefei City, China

“…Some studies used sequencing of the 16S rRNA gene as a standard to verify the accuracy of the species identification system. The results of recognition of E. meningoseptica and E. anophelis were almost the same ( 6 , 8 , 10 – 12 ).…”

“…E. meningoseptica is the most virulent of the six known Elizabethkingia bacterial species ( 5 ). Furthermore, E. meningoseptica is a hospital pathogen, and correct identification of pathogens is essential for clinical diagnosis and treatment ( 6 ). Because of the intrinsic multidrug resistance of E. meningoseptica to commonly used antibiotics including aminoglycosides and β-lactams, the infection caused by this bacteria is difficult to cure and has a high mortality rate ( 1 , 7 ).…”

Nosocomial Elizabethkingia meningoseptica meningitis and bacteremia in a post transsphenoidal hypophysectomy complicated with sagittal sinus thrombosis: A case report

“…Moreover, since one of the virulence factor genes in Elizabethkingia contains phospholipase C, we postulate that the incidence of central venous thrombosis in this patient might also be contributed by the prothrombotic property of this infection. [ 10 ]…”

“…Moreover, since one of the virulence factor genes in Elizabethkingia contains phospholipase C, we postulate that the incidence of central venous thrombosis in this patient might also be contributed by the prothrombotic property of this infection. [10] CONCLUSION Nosocomial E. meningoseptica is rare but difficult to manage and often requires antibiotic combination therapy with prolonged duration, especially in those who have superimposed multi-resistant organisms. Incidence of central venous thrombosis might also be contributed by the infection necessitating prompt therapy of antithrombotic agents and optimization of intravascular volume.…”

“…Biofilm formation also increases the ability of the bacteria to persist on various surfaces and result in meningitis through contaminated medical fluids or devices and hematogenous spread, but the exact pathogenesis is still being studied. [ 10 ] We report a case of successful treatment of simultaneous nosocomial Elizabethkingia meningitis and septicemia in post transsphenoidal hypophysectomy (TSH) for a pituitary macroadenoma patient.…”