Acute Crit Care.  2021 Aug;36(3):256-261. 10.4266/acc.2020.01158.

Clinical features and outcomes of critically ill patients with Elizabethkingia meningoseptica: an emerging pathogen

• Umair A
• Nasir N

• KMID: 2519453
• DOI: http://doi.org/10.4266/acc.2020.01158

Abstract

Background
Elizabethkingia meningoseptica, formerly known as Chryseobacterium meningosepticum, is a non-motile, non-fastidious, catalase and oxidase-positive, aerobic, glucosenon- fermentative, Gram-negative bacillus that was first defined by Elizabeth O. King in 1959. It has emerged as an opportunistic pathogen that has infected patients in extreme age groups and immunocompromised individuals, especially in intensive care settings. There has been an increased interest in this pathogen due to its increasing occurrence around the world, ubiquitous nature, and inherent capacity for antimicrobial resistance.
Methods
We describe an observational study at a tertiary care center in Karachi, Pakistan, based on patients admitted between January 2013 and December 2018, with E. meningoseptica infections. All patients were confirmed to have a positive clinical culture specimen for E. meningoseptica along with symptoms and signs consistent with infection. Data were collected on a structured proforma from the Hospital Information Management Systems.
Results
Sixteen patients with E. meningoseptica that met the criteria for infection were identified, 13 of whom required admission. Eight patients had bacteremia in addition to confirmed E. meningoseptica infection. Two of the isolates were multi-drug resistant and only sensitive to minocycline. Nine out of 13 patients that were admitted required intubation and mechanical ventilation. The median length of hospital stay was 13 days, and five out of the 13 patients died during the hospital stay.
Conclusion
This is the largest case series to date reporting E. meningoseptica infections and highlights the importance of this organism as an emerging nosocomial pathogen.

Keyword

Nosocomial infection

Figure

• 

  Figure 1. Antibiotic susceptibility of Elizabethkingia meningoseptica isolates.

Reference

1. Kim KK, Kim MK, Lim JH, Park HY, Lee ST. Transfer of Chryseobacterium meningosepticum and Chryseobacterium miricola to Elizabethkingia gen. nov. as Elizabethkingia meningoseptica comb. nov. and Elizabethkingia miricola comb. nov. Int J Syst Evol Microbiol. 2005; 55(Pt 3):1287–93.

2. Teo J, Tan SY, Liu Y, Tay M, Ding Y, Li Y, et al. Comparative genomic analysis of malaria mosquito vector-associated novel pathogen Elizabethkingia anophelis. Genome Biol Evol. 2014; 6:1158–65.

3. Jean SS, Lee WS, Chen FL, Ou TY, Hsueh PR. Elizabethkingia meningoseptica: an important emerging pathogen causing healthcare-associated infections. J Hosp Infect. 2014; 86:244–9.

4. Mukerji R, Kakarala R, Smith SJ, Kusz HG. Chryseobacterium indologenes: an emerging infection in the USA. BMJ Case Rep. 2016; 2016:bcr2016214486.

5. Tuon FF, Campos L, Duboc de Almeida G, Gryschek RC. Chryseobacterium meningosepticum as a cause of cellulitis and sepsis in an immunocompetent patient. J Med Microbiol. 2007; 56(Pt 8):1116–7.

6. Meyers SL. A crash course In Elizabethkingia, the rare bacterial infection spreading across Wisconsin [Internet]. Madison (WI): Wisconsin Public Radio;2016. [cited 2021 Jul 1]. Available from: https://www.wpr.org/crash-course-elizabethkingia-rare-bacterial-infection-spreading-across-wisconsin.

7. Hsu MS, Liao CH, Huang YT, Liu CY, Yang CJ, Kao KL, et al. Clinical features, antimicrobial susceptibilities, and outcomes of Elizabethkingia meningoseptica (Chryseobacterium meningosepticum) bacteremia at a medical center in Taiwan, 1999-2006. Eur J Clin Microbiol Infect Dis. 2011; 30:1271–8.

8. Loch TP, Faisal M. Emerging flavobacterial infections in fish: a review. J Adv Res. 2015; 6:283–300.

9. National Healthcare Safety Network. CDC/NHSN surveillance definitions for specific types of infections [Internet]. Atlanta (GA): Centers for Disease Control and Prevention;2021. [cited 2021 Jun 5]. Available from: https://www.cdc.gov/nhsn/pdfs/pscmanual/17pscnosinfdef_current.pdf.

10. Magiorakos AP, Srinivasan A, Carey RB, Carmeli Y, Falagas ME, Giske CG, et al. Multidrug-resistant, extensively drug-resistant and pandrug-resistant bacteria: an international expert proposal for interim standard definitions for acquired resistance. Clin Microbiol Infect. 2012; 18:268–81.

11. Khan ID, Lall M, Sen S, Ninawe SM, Chandola P. Multiresistant Elizabethkingia meningoseptica infections in tertiary care. Med J Armed Forces India. 2015; 71:282–6.

12. Arbune M, Fotea S, Nechita A, Stefanescu V. Emerging infection with Elizabethkingia meningoseptica in neonate: a case report. J Crit Care Med (Targu Mures). 2018; 4:96–100.

13. Celik K, Terek D, Olukman O, Gulfidan G, Calkavur S, Devrim I, et al. Colonization and infection with a rare microorganism in a neonatal intensive care unit: three preterm infants with Elizabethkingia meningoseptica. Arch Argent Pediatr. 2019; 117:e631–4.

14. Hamza WS, Morsi SS, Al Roomi ES, Rotimi VO. Epidemiological analysis of Elizabethkingia meningoseptica infection cluster among mechanically ventilated pediatric intensive care patients. Int J Community Med Public Health. 2018; 5:3212–9.

15. Sahu MK, Balasubramaniam U, C B, Singh SP, Talwar S. Elizabethkingia meningoseptica: an emerging nosocomial pathogen causing septicemia in critically ill patients. Indian J Crit Care Med. 2019; 23:104–5.

16. Raghavan S, Thomas B, Shastry BA. Elizabethkingia meningoseptica: Emerging multidrug resistance in a nosocomial pathogen. BMJ Case Rep. 2017; 2017:bcr2017221076.

17. Dziuban EJ, Franks JL, So M, Peacock G, Blaney DD. Elizabethkingia in children: a comprehensive review of symptomatic cases reported from 1944 to 2017. Clin Infect Dis. 2018; 67:144–9.