Multidrug-resistant Elizabethkingia anophelis septicemia, meningitis, ventriculitis, and hydrocephalus in a preterm neonate: A rare complication of an emerging pathogen

Honavar, Abhijit Goyal; David, Andrew; Amladi, Anushri; Thomas, Leah

doi:10.4103/jpn.jpn_45_20

Cited by 11 publications

(10 citation statements)

References 9 publications

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“…provided guidance for selecting the TMP/SMX dosing regimen of 5 mg/kg/ dose (of TMP) every 12 hours. 13,27 A few neonatal cases reported using combinations including piperacillin-tazobactam; however, this antimicrobial addition was not optimal in our case due to intermediate susceptibility and inadequate CSF penetration. 12,15,28 Use of TMP/SMX in neonates includes additional challenges related to product formulation and administration.…”

Section: Discussionmentioning

confidence: 70%

“…4,8 When our patient’s organism was identified, therapy was changed to a combination regimen used in previously reported cases. 12–15 However, on day 3 of illness, the antimicrobial susceptibility report revealed nonsusceptibility to all drugs tested, except for TMP/SMX. Despite the lack of optimal dosing and safety concerns, TMP/SMX was added, and the 4-drug regimen led to bacterial eradication with no noted adverse effects.…”

Section: Discussionmentioning

confidence: 99%

“…Importantly, only 2 patient cases included doses of antimicrobials utilized, and only 6 of the 9 patients survived. 11–15…”

Section: Discussionmentioning

confidence: 99%

“…Importantly, only 2 patient cases included doses of antimicrobials utilized, and only 6 of the 9 patients survived. [11][12][13][14][15] In the United States, previous reports of E. anophelis infections have been limited to primarily adult patients. One specific institution in Wisconsin reported their clinical experience with 11 adult patients with E. anophelis bacteremia and recommended a combination empiric regimen of piperacillin/tazobactam plus a fluoroquinolone, rifampin or minocycline with vancomycin for severe infections such as meningitis.…”

Section: Discussionmentioning

confidence: 99%

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Successful Eradication of a Highly Resistant Elizabethkingia anophelis Species in a Premature Neonate With Bacteremia and Meningitis

Hartley,

Morrisette,

Malloy

et al. 2023

Pediatric Infectious Disease Journal

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Elizabethkingia anophelis is a Gram-negative bacillus that can exhibit highly resistant phenotypes against most antibiotics with evidence of efficacy and safety in the neonatal population. Given the limited antimicrobial options, clinicians may be forced into challenging treatment scenarios when faced with central nervous system infections in premature neonates caused by E. anophelis. We report a case of successful treatment of hospital-acquired meningitis and bacteremia caused by E. anophelis at 11 days of life in a male infant born at 29 weeks, 1 day gestation and birth weight of 1.41 kg. Therapy consisted of vancomycin, dose adjusted to maintain goal troughs of 15–20 mg/L, and rifampin 10 mg/kg/dose every 12 hours, with ciprofloxacin 15 mg/kg/dose every 12 hours and trimethoprim/sulfamethoxazole 5 mg/kg/dose every 12 hours added due to antimicrobial susceptibilities and unsatisfactory response, for a total of 21 days. Following initiation of this multidrug regimen, repeat cultures were negative, laboratory parameters improved [with exception of elevated cerebrospinal fluid (CSF) white blood cell count], the patient remained otherwise stable, and there were no adverse effects noted from therapy. Complications after treatment included the requirement of bilateral hearing aids and the development of hydrocephalus necessitating ventriculoperitoneal shunt placement. To our knowledge, we report the first case of meningitis in a premature neonate initially identified as E. anophelis in the United States treated with this regimen which led to successful microbiologic eradication with no antimicrobial safety concerns.

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Section: Discussionmentioning

confidence: 70%

Section: Discussionmentioning

confidence: 99%

“…Importantly, only 2 patient cases included doses of antimicrobials utilized, and only 6 of the 9 patients survived. 11–15…”

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Successful Eradication of a Highly Resistant Elizabethkingia anophelis Species in a Premature Neonate With Bacteremia and Meningitis

Hartley,

Morrisette,

Malloy

et al. 2023

Pediatric Infectious Disease Journal

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“…A 12-day-old male neonate with E. anophelis septicaemia and meningitis was treated with intravenous cefoperazone/sulbactam and vancomycin, oral TMP-SMZ, rifampicin, and ciprofloxacin. Although the infant survived, he had a developmental delay at follow-up [145]. The first two individuals with E. anophelis infections in Japan received ciprofloxacin monotherapy and a combination of minocycline plus piperacillin/tazobactam, but neither survived [77].…”

Section: Treatment Options For Elizabethkingia Anophelis Infectionsmentioning

confidence: 99%

Emerging infections in vulnerable hosts: Stenotrophomonas maltophilia and Elizabethkingia anophelis

Lee,

Hsueh

2023

Current Opinion in Infectious Diseases

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Purpose of review This systematic review aimed to explore the recent trends in the epidemiology, risk factors, and antimicrobial susceptibility of two emerging opportunistic pathogens, Stenotrophomonas maltophilia and Elizabethkingia anophelis. Recent findings Since 2020, numerous outbreaks of S. maltophilia and E. anophelis have been reported worldwide. Most of these outbreaks have been associated with healthcare facilities, although one outbreak caused by E. anophelis in France was considered a community-associated infection. In terms of antimicrobial susceptibility, trimethoprim/sulfamethoxazole (TMP-SMZ), levofloxacin, and minocycline have exhibited good efficacy against S. maltophilia. Additionally, cefiderocol and a combination of aztreonam and avibactam have shown promising results in in vitro susceptibility testing. For E. anophelis, there is currently no consensus on the optimal treatment. Although some studies have reported good efficacy with rifampin, TMP-SMZ, piperacillin/tazobactam, and cefoperazone/sulbactam, minocycline had the most favourable in vitro susceptibility rates. Cefiderocol may serve as an alternative due to its low minimum inhibitory concentration (MIC) against E. anophelis. The role of vancomycin in treatment is still uncertain, although several successful cases with vancomycin treatment, even with high MIC values, have been reported. Summary Immunocompromised patients are particularly vulnerable to infections caused by S. maltophilia and E. anophelis, but the optimal treatment strategy remains inconclusive. Further research is necessary to determine the most effective use of conventional and novel antimicrobial agents in combatting these multidrug-resistant pathogens.

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Clinical Profile and Outcome of Neonates with Elizabethkingia Sepsis

2023

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Multidrug-resistant Elizabethkingia anophelis septicemia, meningitis, ventriculitis, and hydrocephalus in a preterm neonate: A rare complication of an emerging pathogen

Cited by 11 publications

References 9 publications

Successful Eradication of a Highly Resistant Elizabethkingia anophelis Species in a Premature Neonate With Bacteremia and Meningitis

Successful Eradication of a Highly Resistant Elizabethkingia anophelis Species in a Premature Neonate With Bacteremia and Meningitis

Emerging infections in vulnerable hosts: Stenotrophomonas maltophilia and Elizabethkingia anophelis

Clinical Profile and Outcome of Neonates with Elizabethkingia Sepsis

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