Invasive paediatric Elizabethkingia meningoseptica infections are best treated with a combination of piperacillin/tazobactam and trimethoprim/sulfamethoxazole or fluoroquinolone

Abstract

Objectives Elizabethkingia meningoseptica is a multi-drug-resistant organism that is associated with high mortality and morbidity in newborn and immunocompromised patients. This study aimed to identify the best antimicrobial therapy for treating this infection. Methods A retrospective descriptive study was conducted from 2010 to 2017 in a tertiary paediatric hospital in Singapore. Paediatric patients aged 0 to 18 years old with a positive culture for E. meningoseptica from any sterile site were identified from the hospital laboratory database. The data collected included clinical characteristics, antimicrobial susceptibility and treatment, and clinical outcomes. Results Thirteen cases were identified in this study. Combination therapy with piperacillin/tazobactam and trimethoprim/sulfamethoxazole or a fluoroquinolone resulted in a cure rate of 81.8 %. The mortality rate was 15.4 % and neurological morbidity in patients with bacteraemia and meningitis remained high (75 %). Conclusions Treatment with combination therapy of piperacillin/tazobactam and trimethoprim/sulfamethoxazole or a fluroquinolone was effective in this study, with low mortality rates being observed.

Comparative Genomics and Antimicrobial Resistance Profiling of Elizabethkingia Isolates Reveal Nosocomial Transmission and In Vitro Susceptibility to Fluoroquinolones, Tetracyclines, and Trimethoprim-Sulfamethoxazole

“…Only levofloxacin and minocycline demonstrated 100% susceptibility using CLSI PK-PD breakpoints. Fluoroquinolone treatment alone has proven to be successful in Elizabethkingia species infections (61), but some recommend combination therapy (62) in order to mitigate high-level fluoroquinolone resistance for those susceptible to single-step mutations. From our and other studies, susceptibility is clearly strain dependent.…”

<p>Molecular Characteristics and Antimicrobial Susceptibility Profiles of <em>Elizabethkingia</em> Clinical Isolates in Shanghai, China</p>

“…37 Furthermore, treatment with combination therapy of piperacillin-tazobactam and trimethoprim-sulfamethoxazole or a fluoroquinolone was reported to be effective in paediatric patients with E. meningoseptica infections, with variable susceptibility of strains to piperacillin-tazobactam (100%), trimethoprim-sulfamethoxazole (78.6%) and fluoroquinolones (33.3-87.5%). 38 The restoration of activity with β-lactam inhibitors may be explained by the production of ESBLs genes such as bla CME especially when MBLs were expressed at a low level, along with decreased outer membrane permeability involved in the carbapenem-resistant Elizabethkingia isolates. 39 Despite the favorable activity of β-lactam/βlactamase inhibitor combinations as a part of the combination regimen, there was little evidence over their use as monotherapy for patients.…”

Comparative genomics and antimicrobial resistance profiling of Elizabethkingia isolates reveals nosocomial transmission and in vitro susceptibility to fluoroquinolones, tetracyclines and trimethoprim-sulfamethoxazole

“…Fluoroquinolone treatment alone has proven to be successful in Elizabethkingia spp. infections 64 , yet some recommend combination therapy 65 in order to mitigate high-level fluoroquinolone resistance for those susceptible to single step mutations. From our and other studies, susceptibility is clearly strain dependent.…”