Experience with Elizabethkingia meningoseptica Infection in Adult Patients at a Tertiary Hospital

Abstract

Background: Few reports have documented the clinical characteristics and treatment outcomes of adult patients with Elizabethkingia meningoseptica infection. Methods: Medical records of patients over 18 years of age and suspected of having an E. meningoseptica infection from March 1, 2006 to February 28, 2013 were reviewed retrospectively. Their clinical characteristics, antimicrobial susceptibility results, and treatment outcomes were analyzed. Results: E. meningoseptica was isolated from 30 patients. Median age was 68.5 years, and infections were more frequent in males (17, 56.7%). The most common isolation source was sputum (23, 76.7%), and pneumonia was the most common condition (21, 70%) after excluding two cases of colonization. This bacterium was most susceptible to minocycline (27, 90%) and fluoroquinolones, including levofloxacin (20, 66.7%) and ciprofloxacin (18, 60%). The mortality rate due directly to E. meningoseptica infection was 20% (6/30), and uncontrolled pneumonia was the only cause of death. After isolating E. meningoseptica, the numbers of patients with pneumonia (9/9, 100% vs. 12/21, 57.1%), history of hemodialysis (5/9, 55.6% vs. 3/21, 14.3%), tracheostomy (8/9, 88.9 vs. 10/21, 47.6%), and median Charlson comorbidity index score (6 [range, 3-9] vs. 4 [range, 0-9]) were significantly higher in non-survivors than those in survivors (p < 0.05, for each). However, only 12 (40%) patients received appropriate antibiotics. Conclusions: E. meningoseptica infection most commonly presented as pneumonia in adults with severe underlying diseases. Despite the high mortality rate, the rate of appropriate antibiotic use was notably low.

Elizabethkingia meningosepticum Isolated from Pleural Fluid: A Diagnostic Dilemma

“…When isolated from a clinical specimen, E. meningosepticum is significant in up to half of the adults and in about two-thirds of the neonates 1 and carries mortality in up to 20%-30%. 14 It usually affects patients with severe underlying illness. [6][7][8][9][10][11][12] The respiratory tract is the most common site of infection.…”

Uncommon Pathogens Causing Hospital-Acquired Infections in Postoperative Cardiac Surgical Patients

“…Choosing an effective antibiotic against Elizabethkingia is quite difficult because no interpretive minimum inhibitory concentration and breakpoints of antibiotics against this organism have been reported. 55 Elizabethkingia spp. are resistant to multiple antibiotics, especially to aminoglycosides, β-lactam antibiotics, tetracyclines, and chloramphenicol.…”

“…It is often susceptible to agents generally used to treat infections caused by Gram-positive bacteria (rifampicin, clindamycin, erythromycin, trimethoprim-sulfamethoxazole, quinolones, and vancomycin). 55 Many of the bacteria possess two different types of β-lactamases, namely class A extended-spectrum β-lactamases (ESBLs) and class B metallo-β-lactamases; the latter confer resistance to carbapenems, which makes the treatment difficult.…”