Risk factors for mortality in Elizabethkingia spp. bloodstream infections

Area of Science:

• Infectious Diseases
• Clinical Microbiology
• Hospital Epidemiology

Background:

• Elizabethkingia spp. are challenging healthcare-associated pathogens.
• Lack of defined clinical breakpoints for key antibiotics complicates treatment.
• Identifying mortality predictors is crucial for patient management.

Purpose of the Study:

• To identify clinical, laboratory, and microbiological factors associated with mortality in Elizabethkingia spp. bacteraemia.
• To evaluate the correlation between antimicrobial susceptibility testing minimum inhibitory concentrations (MICs) and outcomes for specific antibiotic regimens.
• To inform treatment strategies for Elizabethkingia infections.

Main Methods:

• Retrospective analysis of 127 Elizabethkingia spp. bacteraemia cases (2012-2024).
• Comparison of patients with in-hospital mortality versus survivors.
• Subgroup analysis of patients treated with piperacillin-tazobactam, levofloxacin, or trimethoprim-sulfamethoxazole (TMP-SMX) to assess MIC correlations.

Main Results:

• In-hospital mortality rate was 29.9%.
• Prolonged fever, elevated C-reactive protein, white cell count, and lactate dehydrogenase levels were associated with mortality.
• Elevated levofloxacin MICs correlated with adverse outcomes, but not for piperacillin-tazobactam or TMP-SMX. No antibiotic regimen was independently linked to survival.

Conclusions:

• Prolonged fever and elevated C-reactive protein are independent predictors of mortality.
• Levofloxacin MICs, but not piperacillin-tazobactam or TMP-SMX MICs, appear to correlate with outcomes.
• Further research is needed to establish clinical breakpoints for Elizabethkingia spp.