“Unmasking the Uncommon”: A case series of multi-drug resistant Elizabethkingia meningoseptica causing late-onset sepsis and meningitis in preterm neonates [version 2; peer review: 2 approved]
Elizabethkingia meningoseptica is an uncommon nosocomial pathogen that causes meningitis, pneumonia, and sepsis in neonates and in immunocompromised individuals. It exhibits resistance to many commonly employed first-line antibiotics used to treat gram-negative pathogens. Herein, we present three ca...
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F1000 Research Ltd
2025-02-01
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| author | Anisha Maria Fernandes Sinchana Bhat Suchitra Shenoy M. Prajnha U.P. |
| author_facet | Anisha Maria Fernandes Sinchana Bhat Suchitra Shenoy M. Prajnha U.P. |
| author_sort | Anisha Maria Fernandes |
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| description | Elizabethkingia meningoseptica is an uncommon nosocomial pathogen that causes meningitis, pneumonia, and sepsis in neonates and in immunocompromised individuals. It exhibits resistance to many commonly employed first-line antibiotics used to treat gram-negative pathogens. Herein, we present three cases of late-onset sepsis with multi-drug resistant (MDR) Elizabethkingia meningoseptica in high-risk neonates. Case 1 was a one-day-old preterm low-birth-weight infant who presented with respiratory distress syndrome and septic shock. The patient was intubated and administered empirical broad-spectrum antibiotics and antifungal agents. Blood culture grew Candida krusei, hence Amphotericin B was initiated. Repeat blood culture on day 27 showed gram-negative bacilli, identified as Elizabethkingia meningoseptica by MALDI-TOF . Antibiotic susceptibility testing (AST) revealed resistance to Piperacillin/Tazobactam, but sensitivity to Vancomycin, Levofloxacin, and Minocycline. IV Vancomycin was administered, which resulted in clinical improvement and negative blood culture results. Case 2 was an eleven-day-old preterm, low-birth-weight baby who presented with fever. Initial investigations revealed normal complete blood counts (CBC) parameters and elevated CRP levels. Blood and CSF cultures isolated Elizabethkingia meningoseptica with a similar AST pattern. Intravenous Ciprofloxacin was initiated with clinical improvement and negative follow-up blood cultures. Case 3 was a one-day-old preterm baby, appropriate-to-gestational age, presenting with respiratory distress syndrome. The infant was intubated and started on inotropic support and intravenous antibiotics. Blood cultures on day 4 showed Elizabethkingia meningoseptica and Vancomycin was started. Follow-up cultures on days 6 and 14 grew Acinetobacter baumannii. A combination of Levofloxacin and Colistin was added, and blood cultures were negative after seven days, with clinical improvement. Elizabethkingia meningoseptica is a significant cause of hospital-acquired infections, especially in Neonatal Intensive Care Unit (NICU), leading to outbreaks. Clinicians must have a high degree of suspicion of E. meningoseptica for gram-negative bacilli causing sepsis and meningitis in high-risk patients. Recent technological advances have enabled accurate speciation to guide therapy and reduce morbidity and mortality rates. |
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| institution | Kabale University |
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| language | English |
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| spelling | doaj-art-52986529b7c9444286cd137bfa995f902025-02-12T01:00:03ZengF1000 Research LtdF1000Research2046-14022025-02-0113177523“Unmasking the Uncommon”: A case series of multi-drug resistant Elizabethkingia meningoseptica causing late-onset sepsis and meningitis in preterm neonates [version 2; peer review: 2 approved]Anisha Maria Fernandes0https://orcid.org/0000-0002-0374-975XSinchana Bhat1Suchitra Shenoy M.2https://orcid.org/0000-0003-1425-0097Prajnha U.P.3Department of Microbiology, Kasturba Medical College, Mangalore,, Manipal Academy of Higher Education, Manipal, Karnataka, 576104, IndiaRegional Advanced Paediatric Care Centre, Government Wenlock Hospital, Mangalore, Manipal Academy of Higher Education, Manipal, Karnataka, 576104, IndiaDepartment of Microbiology, Kasturba Medical College, Mangalore,, Manipal Academy of Higher Education, Manipal, Karnataka, 576104, IndiaDepartment of Microbiology, Kasturba Medical College, Mangalore,, Manipal Academy of Higher Education, Manipal, Karnataka, 576104, IndiaElizabethkingia meningoseptica is an uncommon nosocomial pathogen that causes meningitis, pneumonia, and sepsis in neonates and in immunocompromised individuals. It exhibits resistance to many commonly employed first-line antibiotics used to treat gram-negative pathogens. Herein, we present three cases of late-onset sepsis with multi-drug resistant (MDR) Elizabethkingia meningoseptica in high-risk neonates. Case 1 was a one-day-old preterm low-birth-weight infant who presented with respiratory distress syndrome and septic shock. The patient was intubated and administered empirical broad-spectrum antibiotics and antifungal agents. Blood culture grew Candida krusei, hence Amphotericin B was initiated. Repeat blood culture on day 27 showed gram-negative bacilli, identified as Elizabethkingia meningoseptica by MALDI-TOF . Antibiotic susceptibility testing (AST) revealed resistance to Piperacillin/Tazobactam, but sensitivity to Vancomycin, Levofloxacin, and Minocycline. IV Vancomycin was administered, which resulted in clinical improvement and negative blood culture results. Case 2 was an eleven-day-old preterm, low-birth-weight baby who presented with fever. Initial investigations revealed normal complete blood counts (CBC) parameters and elevated CRP levels. Blood and CSF cultures isolated Elizabethkingia meningoseptica with a similar AST pattern. Intravenous Ciprofloxacin was initiated with clinical improvement and negative follow-up blood cultures. Case 3 was a one-day-old preterm baby, appropriate-to-gestational age, presenting with respiratory distress syndrome. The infant was intubated and started on inotropic support and intravenous antibiotics. Blood cultures on day 4 showed Elizabethkingia meningoseptica and Vancomycin was started. Follow-up cultures on days 6 and 14 grew Acinetobacter baumannii. A combination of Levofloxacin and Colistin was added, and blood cultures were negative after seven days, with clinical improvement. Elizabethkingia meningoseptica is a significant cause of hospital-acquired infections, especially in Neonatal Intensive Care Unit (NICU), leading to outbreaks. Clinicians must have a high degree of suspicion of E. meningoseptica for gram-negative bacilli causing sepsis and meningitis in high-risk patients. Recent technological advances have enabled accurate speciation to guide therapy and reduce morbidity and mortality rates.https://f1000research.com/articles/13-1367/v2Elizabethkingia meningoseptica late-onset sepsis meningitis Multi-drug resistanceeng |
| spellingShingle | Anisha Maria Fernandes Sinchana Bhat Suchitra Shenoy M. Prajnha U.P. “Unmasking the Uncommon”: A case series of multi-drug resistant Elizabethkingia meningoseptica causing late-onset sepsis and meningitis in preterm neonates [version 2; peer review: 2 approved] F1000Research Elizabethkingia meningoseptica late-onset sepsis meningitis Multi-drug resistance eng |
| title | “Unmasking the Uncommon”: A case series of multi-drug resistant Elizabethkingia meningoseptica causing late-onset sepsis and meningitis in preterm neonates [version 2; peer review: 2 approved] |
| title_full | “Unmasking the Uncommon”: A case series of multi-drug resistant Elizabethkingia meningoseptica causing late-onset sepsis and meningitis in preterm neonates [version 2; peer review: 2 approved] |
| title_fullStr | “Unmasking the Uncommon”: A case series of multi-drug resistant Elizabethkingia meningoseptica causing late-onset sepsis and meningitis in preterm neonates [version 2; peer review: 2 approved] |
| title_full_unstemmed | “Unmasking the Uncommon”: A case series of multi-drug resistant Elizabethkingia meningoseptica causing late-onset sepsis and meningitis in preterm neonates [version 2; peer review: 2 approved] |
| title_short | “Unmasking the Uncommon”: A case series of multi-drug resistant Elizabethkingia meningoseptica causing late-onset sepsis and meningitis in preterm neonates [version 2; peer review: 2 approved] |
| title_sort | unmasking the uncommon a case series of multi drug resistant elizabethkingia meningoseptica causing late onset sepsis and meningitis in preterm neonates version 2 peer review 2 approved |
| topic | Elizabethkingia meningoseptica late-onset sepsis meningitis Multi-drug resistance eng |
| url | https://f1000research.com/articles/13-1367/v2 |
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