Risk Factors for Mortality in Patients with Elizabethkingia Infection and the Clinical Impact of the Antimicrobial Susceptibility Patterns of Elizabethkingia Species

Abstract

Elizabethkingia species (spp.), which can colonize hospital environments, are emerging nosocomial pathogens presenting high mortality. Due to their intrinsic resistance to a broad range of antibiotics, optimal antibiotic dosage has yet to be determined against infections caused by Elizabethkingia spp. This study aimed to investigate the risk factors for the mortality of infections caused by Elizabethkingia spp. and assess the clinical implications of their antimicrobial susceptibility patterns. Data from 210 patients affected by Elizabethkingia-induced pneumonia and bacteremia between 1 November 2005 and 31 May 2016, were analyzed. Further antimicrobial susceptibility tests for moxifloxacin, rifampin, and vancomycin using Elizabethkingia isolates were performed to compensate for the Elizabethkingia spp. susceptibility panel in patients affected after 2013. The mean age of the patients was 66.5 ± 18 years and the 28-day mortality rate was 25.2% (53/210). In the univariate analysis, history of prior stay in an intensive care unit, central venous catheter use, presented thrombocytopenia, immunocompetent status, a high simplified acute physiology score II (SAPS II score), a high C-reactive protein (CRP)/albumin ratio on the day of isolation and seven days later, and a high minimum inhibitory concentration (MIC) value of rifampin were significantly associated with a higher mortality rate. In the multivariate logistic regression analysis, the MIC values of rifampin (odds ratio (OR): 1.045; 95% confidence interval (CI): 1.006–1.085; p = 0.023), SAPS II score (OR: 1.053; 95% CI: 1.022–1.084; p = 0.001), and initial CRP/albumin ratio (OR: 1.030; 95% CI: 1.009–1.051; p = 0.004) were significantly associated with 28-day mortality. To reduce the mortality associated with Elizabethkingia infections, prediction of the clinical course using initial CRP/albumin ratio and SAPS II and early intervention are essential. Rifampin is a promising candidate as the drug of choice in treating Elizabethkingia infections.

Epidemiology and Characteristics of Elizabethkingia spp. Infections in Southeast Asia

“…The Gram-negative bacteria of the genus Elizabethkingia have recently emerged as an important pathogen in hospital-acquired infections and are generally associated with high mortality [ 1 ]. Recent literature has reported several cases of severe infection in humans owing to this organism, with neonatal meningitis most commonly presented in children [ 2 ], accompanied by a range of other clinical manifestations such as septicemia and bacteremia [ 3 , 4 ], osteomyelitis [ 5 ], urinary tract infections [ 6 , 7 ], endogenous endophthalmitis [ 8 ], endocarditis [ 9 ], epididymo-orchitis [ 10 ], pulmonary abscess [ 11 ], necrotizing fasciitis [ 12 , 13 ], cystic fibrosis [ 14 ], hydrocephalus [ 15 ], and secondary infections with a high mortality rate, particularly in immunocompromised patients [ 16 ]. Elizabethkingia meningoseptica infections have also been associated with COVID-19 patients [ 17 ].…”

The Diagnostic Significance of Usual Biochemical Parameters in Coronavirus Disease 19 (COVID-19): Albumin to Globulin Ratio and CRP to Albumin Ratio

“…In addition, a higher CRP to albumin ratio at admission has been determined as a risk factor for in-hospital mortality in elderly patients with acute kidney injury requiring dialysis (21). Similarly, an initial elevated CRP to albumin ratio was significantly related to 28-day mortality associated with infections caused by Elizabethkingia spp., a dangerous opportunistic bacterial pathogen causing different illnesses including pneumonia (22). The authors concluded that the prediction of clinical courses using an initial CRP to albumin ratio is a priority to reduce the mortality in these patients.…”

Biofilm formation and antibiotic sensitivity in Elizabethkingia anophelis

“…found that rifampin is unproductive to against E. anophelis , and the susceptibility rate was only 20.5% ( Chang et al., 2021 ). Nevertheless, in most other studies, it was reported that rifampin is potent in fighting E. anophelis bacteria; even more than 95% of strains remained sensitive ( Han et al., 2017 ; Seong et al., 2020 ; Wang et al., 2020 ; Chiu et al., 2021 ). Corresponding to these reports, rifampin also showed high in vitro activity inhibiting E. anophelis in our study.…”