Neonatal bacteremia and meningitis caused by Elizabethkingia, treatment and challenges: a case report and literature review
DOI:
https://doi.org/10.18203/2349-3291.ijcp20253321Keywords:
Elizabethkingia meningoseptica, Neonatal sepsis, Multidrug resistance, Premature infants, Infection controlAbstract
Elizabethkingia is a gram-negative, rod-shaped bacterial genus that is commonly detected in the environment (particularly in soil and water), but it rarely causes human infection; however, following an increased incidence of Elizabethkingia infections among patients in adulthood, pediatric and neonatal intensive care units, since 2004. Elizabethkingia is considered an emerging pathogen in hospital settings, and it has been linked to outbreaks due to contaminated medical equipment. Moreover, this infection can also be a pathogen causing neonatal sepsis which is associated with high rates of morbidity and mortality, including potential long-term neurological complications. Early recognition as well as identification of appropriate, often prolonged, combination of antibiotic therapy is essential in managing such infections. In our report, we present a case of acute meningitis caused by E. meningoseptica in a premature baby 33 weeks of gestational age, admitted to our pediatric word at the 13 days old as a case of neonatal fever, with past history of 18 hours PROM and oligohydramnios. The organism is identified through blood and cerebrospinal fluid cultures. For the treatment of this infection, we started on triple antibiotic therapy (Rifampicin, vancomycin and trimethoprim/sulphamethoxazole) due to known multidrug resistance to many standard antibiotic regimens, making treatment challenging mainly in preterm babies and immunocompromised children. In conclusion, effective management of multidrug resistant bacteria such Elizabethkingia requires a multidisciplinary approach, including intensive care support (in some cases), and coordination with infection control teams to prevent further transmission and improve the outcome.
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King EO. Studies on a group of previously unclassified bacteria associated with meningitis in infants. Am J Clin Pathol. 1959;31(3):241-7. DOI: https://doi.org/10.1093/ajcp/31.3.241
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(3):1287-93. DOI: https://doi.org/10.1099/ijs.0.63541-0
Bloch KC, Nadarajah R, Jacobs R. Elizabethkingia meningoseptica: an emerging cause of neonatal meningitis. Clin Infect Dis. 1997;24(3):566-9.
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(4):244-9. DOI: https://doi.org/10.1016/j.jhin.2014.01.009
Kothur K, Teng W, Nair S, Britton PN, Smith DW, Yau Y. Neurological sequelae due to Elizabethkingia meningoseptica meningitis in neonates: a systematic review. J Child Neurol. 2017;32(10):798-803.
Lin PY, Chu C, Su LH, Huang CT, Chang WY, Chiu CH. Clinical and microbiological analysis of Elizabethkingia meningoseptica bacteremia in adult patients in Taiwan. Scand J Infect Dis. 2009;41(9):628-34. DOI: https://doi.org/10.1080/00365540903089476
Lau SKP, Chow WN, Foo CH, Shirly OTC, Chi-Shing LG, Jade LLT, et al. Elizabethkingia anophelis bacteremia is associated with clinically significant infections and high mortality. Sci Rep. 2016;6:26045. DOI: https://doi.org/10.1038/srep26045
Ku LC, Boggess KA, Cohen-Wolkowiez M. Bacterial meningitis in infants. Clin Perinatol. 2015;42(1):29-45. DOI: https://doi.org/10.1016/j.clp.2014.10.004
Abdelaziz M, Hamadalnil Y, Hashim O, Bashir T, Mahjoub ES. Microbiological profile of neonatal sepsis at a maternity hospital in Omdurman, Sudan. Sudan J Med Sci. 2019;14(1):45-51. DOI: https://doi.org/10.18502/sjms.v14i1.4380
Sztajnbok J and Troster EJ. Community acquired Chryseobacterium meningosepticum pneumonia and sepsis in a previously healthy child. J Infect. 1998;37:310-12. DOI: https://doi.org/10.1016/S0163-4453(98)92572-5
Aldoghaim FS, Kaabia N, Alyami AM, Alqasim MA, Ahmed MA, Al Aidaroos A, et al. E. meningoseptica (Chryseobacterium meningosepticum) bacteraemia: a series of 12 cases at Prince Sultan Military Medical City KSA. New Microbes New Infect. 2019;32:100617. DOI: https://doi.org/10.1016/j.nmni.2019.100617
Bloch KC, Nadarajah R, Jacobs R. Chryseobacterium meningosepticum: an emerging pathogen among immunocompromised adults. Report of 6 cases and literature review. Medicine (Baltimore). 1997;76(1):30-41. DOI: https://doi.org/10.1097/00005792-199701000-00003
Choi MH, Kim M, Jeong SJ, Choi JY, Lee IY, Yong TS, et al. Risk factors for Elizabethkingia acquisition and clinical characteristics of patients, South Korea. Emerg Infect Dis. 2019;25(1):42-51. DOI: https://doi.org/10.3201/eid2501.171985
Han MS, Kim H, Lee Y, Kim M, Ku NS, Choi JY, et al. Relative prevalence and antimicrobial susceptibility of clinical isolates of Elizabethkingia species based on 16S rRNA gene sequencing. J Clin Microbiol. 2016;55(1):274-80. DOI: https://doi.org/10.1128/JCM.01637-16
Huang YC, Lin YT, Wang FD. Comparison of the therapeutic efficacy of fluoroquinolone and non-fluoroquinolone treatment in patients with Elizabethkingia meningoseptica bacteraemia. Int J Antimicrob Agents 2018;51(1):47-51. DOI: https://doi.org/10.1016/j.ijantimicag.2017.05.018
Hayek SS, Abd TT, Cribbs SK, Anderson AM, Melendez A, Kobayashi M, et al. Rare Elizabethkingia meningosepticum meningitis case in an immunocompetent adult. Emerg Microbes Infect. 2013;2(4):e17. DOI: https://doi.org/10.1038/emi.2013.16
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