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Elizabethkingia meningosepticum in a Patient with Six-Year Bilateral Perma-Catheters
1Nassau University Medical Center, 2201 Hempstead Tpke, East Meadow, NY 11554, USA.
Abstract:
Elizabethkingia meningosepticum (EM) is a saprophyte which is ubiquitous in nature, but not normally present in the human flora. Instances of infection are rare in the USA, but EM may be an emerging pathogen among immune-compromised patients. EM can cause a variety of infections, but nosocomial pneumonia and bacteremia have been the most commonly reported among immune-compromised adults. EM has proven difficult to treat with a mortality rate of 23%-41% in adult bacteremia. This is likely due to its resistance to commonly used empiric antibiotics for Gram-negative infections. A review of the literature suggests that there has been a shift EM's susceptibility profile over time along with a great variability in antibiotic susceptibilities reported. This signifies the importance of close monitoring of these changes. In this report we present a case of a 64-year-old male with end stage renal disease and bilateral subclavian perma-catheters, who was admitted with systemic inflammatory response syndrome. While initial peripheral blood cultures were negative, cultures later drawn from his perma-catheters revealed Corneybacterium species and EM. The patient was initially treated with empiric vancomycin and piperacillin-tazobactam. After antibiotics susceptibilities became available, he was treated with levofloxacin and ceftazidime. The patient improved, was culture negative, and later had perma-catheter removal.
Insights
Elizabethkingia meningosepticum (EM) is an emerging pathogen in immunocompromised individuals. This case highlights successful treatment of EM bacteremia using targeted antibiotics after initial empiric therapy failed.
Area of Science:
- Infectious Diseases
- Microbiology
- Critical Care Medicine
Background:
- Elizabethkingia meningosepticum (EM) is a rare but emerging pathogen, particularly in immunocompromised patients.
- EM infections, including nosocomial pneumonia and bacteremia, are associated with high mortality rates (23%-41%) due to antibiotic resistance.
- Susceptibility profiles of EM vary significantly and change over time, necessitating vigilant monitoring.
Purpose of the Study:
- To report a case of Elizabethkingia meningosepticum bacteremia in an immunocompromised patient.
- To illustrate the challenges in treating EM infections due to evolving antibiotic resistance.
- To emphasize the importance of timely susceptibility testing and targeted antibiotic therapy.
Main Methods:
- Case report of a 64-year-old male with end-stage renal disease and central venous catheters.
- Initial presentation with systemic inflammatory response syndrome.
- Blood cultures from peripheral sites and central catheters were analyzed.
- Empiric antibiotic therapy was initiated, followed by targeted treatment based on susceptibility results.
Main Results:
- Elizabethkingia meningosepticum and Corynebacterium species were isolated from central venous catheter blood cultures.
- Initial empiric treatment with vancomycin and piperacillin-tazobactam was ineffective.
- Subsequent treatment with levofloxacin and ceftazidime resulted in clinical improvement and negative cultures.
- The patient's perma-catheters were successfully removed.
Conclusions:
- Elizabethkingia meningosepticum poses a significant therapeutic challenge, particularly in patients with indwelling devices.
- Accurate and rapid antibiotic susceptibility testing is crucial for effective management of EM infections.
- Targeted antibiotic therapy, guided by susceptibility data, can lead to successful patient outcomes.
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