Antimicrobial management and infection outcomes of Elizabethkingia spp. co-detection in lower respiratory tract: A...

Elizabethkingia spp. infections pose a major threat to human health with high mortality. This study aimed to further understand its detection status, co-detection patterns, pathogenicity, and antimicrobial resistance in lower respiratory tract infections (LRTI) through metagenomic high throughput sequencing (mNGS)-based real-world research.

We retrospectively analyzed 105 LRTI patients positive for Elizabethkingia spp. by mNGS from July 2021 to February 2025. Pathogen profiles, antimicrobial management, and outcomes were reviewed via electronic medical records.

mNGS detection rates for Elizabethkingia spp. in respiratory samples were 21.5% in General Intensive Care Unit (GICU) and 11.1% in Emergency Intensive Care Unit (EICU), more sensitive than culture. Polymicrobial co-detection was ubiquitous (99%), indicating a diverse polymicrobial community. Clinical isolates exhibited variable susceptibility (74%-100%) to trimethoprim-sulfamethoxazole, ciprofloxacin, levofloxacin, doxycycline, minocycline, rifampicin, and azithromycin. Patients receiving targeted antimicrobial therapy based on mNGS indicators (Stringent Map Read Number (SMRN) rank ≤2, normalized SMRN (nSMRN) ≥1000, or SMRN percentage ≥25%) had significantly higher effective treatment rates.

Elizabethkingia spp. detection rates in ICU respiratory samples are high, frequently complicated by polymicrobial co-detection. Lack of targeted therapy is a key factor in treatment failure. mNGS-derived indicators and local susceptibility databases are essential for guiding effective intervention.