Elizabethkingia miricola mediastinitis and bacteraemia

Elizabethkingia species, including Elizabethkingia miricola, are rare opportunistic Gram-negative bacteria. We present a case of E. miricola bloodstream infection associated with a polymicrobial mediastinitis. A male in his 70s underwent an elective Nissen fundoplication, deteriorated on day one post surgery and was transferred to the intensive care unit. Blood cultures revealed E. miricola A CT scan revealed an air and fluid collection posterior to the heart, moderate bilateral pleural effusions, an extensive pneumomediastinum, pockets of free air within the upper abdomen and a splenic infarct. A mediastinal drain and pleural drains were inserted, which cultured E. miricola, Candida albicans, Staphylococcus aureus and anaerobes. The patient was treated with piperacillin-tazobactam and fluconazole with a good response. E. miricola is intrinsically resistant to multiple antibiotic classes, including carbapenems and aminoglycosides. The lack of published cases combined with resistance makes management challenging. Our case highlighted the need for a combination of antibiotic therapy and source control.