Sepsis Caused by Elizabethkingia meningoseptica Successfully Treated by Polymyxin B: A Case Report
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Keywords

Chryseobacterium
Polymyxin B
Meropenem
Sepsis

How to Cite

Yu , M. ., Qi , B. ., Zou , Q. ., Zheng , S. ., Liu , C., & Ma , J. . (2020). Sepsis Caused by Elizabethkingia meningoseptica Successfully Treated by Polymyxin B: A Case Report. Iranian Red Crescent Medical Journal, 22(2). Retrieved from https://ircmj.com/index.php/IRCMJ/article/view/585

Abstract

Introduction: Elizabethkingia meningoseptica (EM) is a non-fermenting Gram-negative bacterium that is a conditional pathogen and easily causes infection in neonates and immunocompromised patients. The infection of the bacterium is prone to develop multi-drug resistance, difficult to treat, and associated with a high mortality rate.

Case Presentation: A 28-year-old female was admitted to the intensive care unit (ICU) of our hospital due to fulminant myocarditis, cardiogenic shock, acute heart failure, and multiple organ dysfunction syndrome (MODS) on 24 April 2019. The patient developed a lung infection and sepsis after admission. Two sputum culture tests on 27 April and 4 May showed infection with Pseudomonas aeruginosa and multi-drug resistance. The minimum inhibitory concentration (MIC) for imipenem was 4 mg/L and 8 mg/L, respectively. Four blood cultures on 9 May suggested an EM infection and multi-drug resistance, the MIC for imipenem was ≥ 16 mg/L. Due to the serious condition of the patient, imipenem-resistant lung infection, and typical sepsis manifestations, we initiated a regimen of polymyxin B combined with meropenem between 3 and 12 May. The infection was well-controlled and the patient was discharged on 14 May.

Conclusions: A polymyxin B-based combinational regimen is effective in the treatment of sepsis due to EM and play an important role in controlling EM-associated mixed infections.

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References

  1. Bloch KC, Nadarajah R, Jacobs R. Chryseobacterium meningosepticum: An emerging pathogen among immunocompromised adults. Report of 6 cases and literature review. Medicine (Baltimore). 1997;76(1):30-41. doi: 10.1097/00005792-199701000-00003. [PubMed: 9064486].
  2. Ceyhan M, Celik M. Elizabethkingia meningosepticum (Chryseobacterium meningosepticum) Infections in Children. Int J Pediatr. 2011;2011:215237. doi: 10.1155/2011/215237. [PubMed: 22046191]. [PubMed Central: PMC3199185].
  3. Lin PY, Chu C, Su LH, Huang CT, Chang WY, Chiu CH. Clinical and microbiological analysis of bloodstream infections caused by Chryseobacterium meningosepticum in nonneonatal patients. J Clin Microbiol. 2004;42(7):3353-5. doi: 10.1128/JCM.42.7.3353-3355.2004. [PubMed: 15243115]. [PubMed Central: PMC446307].
  4. Chiu CH, Waddingdon M, Greenberg D, Schreckenberger PC, Carnahan AM. Atypical Chryseobacterium meningosepticum and meningitis and sepsis in newborns and the immunocompromised, Taiwan. Emerg Infect Dis. 2000;6(5):481-6. doi: 10.3201/eid0605.000506. [PubMed: 10998378]. [PubMed Central: PMC2627967].
  5. Boroda K, Li L. Elizabethkingia meningosepticum in a patient with six-year bilateral perma-catheters. Case Rep Infect Dis. 2014;2014:985306. doi: 10.1155/2014/985306. [PubMed: 25161782]. [PubMed Central: PMC4139023].
  6. Bellais S, Poirel L, Naas T, Girlich D, Nordmann P. Genetic-biochemical analysis and distribution of the Ambler class A beta-lactamase CME-2, responsible for extended-spectrum cephalosporin resistance in Chryseobacterium (Flavobacterium) meningosepticum. Antimicrob Agents Chemother. 2000;44(1):1-9. [PubMed: 10602714]. [PubMed Central: PMC89619].
  7. Hung PP, Lin YH, Lin CF, Liu MF, Shi ZY. Chryseobacterium meningosepticum infection: Antibiotic susceptibility and risk factors for mortality. J Microbiol Immunol Infect. 2008;41(2):137-44. [PubMed: 18473101].
  8. Gonzalez LJ, Vila AJ. Carbapenem resistance in Elizabethkingia meningoseptica is mediated by metallo-beta-lactamase BlaB. Antimicrob Agents Chemother. 2012;56(4):1686-92. doi: 10.1128/AAC.05835-11. [PubMed: 22290979]. [PubMed Central: PMC3318372].
  9. Perera S, Palasuntheram C. Chryseobacterium meningosepticum infections in a dialysis unit. Ceylon Med J. 2004;49(2):57-60. [PubMed: 15334801].
  10. Lin YT, Chan YJ, Chiu CH, Lin ML, Yu KW, Wang FD, et al. Tigecycline and colistin susceptibility of Chryseobacterium meningosepticum isolated from blood in Taiwan. Int J Antimicrob Agents. 2009;34(1):100-1. doi: 10.1016/j.ijantimicag.2009.01.011. [PubMed: 19261450].
  11. Hsu MS, Liao CH, Huang YT, Liu CY, Yang CJ, Kao KL, et al. Clinical features, antimicrobial susceptibilities, and outcomes of Elizabethkingia meningoseptica (Chryseobacterium meningosepticum) bacteremia at a medical center in Taiwan, 1999-2006. Eur J Clin Microbiol Infect Dis. 2011;30(10):1271-8. doi: 10.1007/s10096-011-1223-0. [PubMed: 21461847].
  12. Dias M, Fernandes A, Furtado Z. Case series: Elizabethkingia meningosepticum. J Clin Diagn Res. 2012;6(9):1550-1. doi: 10.7860/JCDR/2012/4076.2557. [PubMed: 23285454]. [PubMed Central: PMC3527794].
  13. Lee CH, Lin WC, Chia JH, Su LH, Chien CC, Mao AH, et al. Community-acquired osteomyelitis caused by Chryseobacterium meningosepticum: Case report and literature review. Diagn Microbiol Infect Dis. 2008;60(1):89-93. doi: 10.1016/j.diagmicrobio.2007.07.009. [PubMed: 17889489].
  14. Bayrak B, Fincanci M, Binay UD, Cimen C, Ozkantar Unlugunes GU. [Elizabethkingia meningosepticum bacteremia in a patient with Bardet-Biedl syndrome and chronic renal failure]. Mikrobiyol Bul. 2014;48(3):495-500. Turkish. [PubMed: 25052117].
  15. Soman R, Agrawal U, Suthar M, Desai K, Shetty A. Successful management of Elizabethkingia meningoseptica meningitis with intraventricular vancomycin. J Assoc Physicians India. 2016;64(10):98-9. [PubMed: 27766817].
  16. Esteban I, Morales C, Pinheiro JL, Galvan ME, Isasmendi A, Castanos C. [Bullous pneumonia secondary to Elizabethkingia meningoseptica, its clinical and radiological evolution]. Arch Argent Pediatr. 2019;117(2):e150-4. Spanish. doi: 10.5546/aap.2019.e150. [PubMed: 30869495].
  17. Tai IC, Liu TP, Chen YJ, Lien RI, Lee CY, Huang YC. Outbreak of Elizabethkingia meningoseptica sepsis with meningitis in a well-baby nursery. J Hosp Infect. 2017;96(2):168-71. doi: 10.1016/j.jhin.2016.11.018. [PubMed: 28077242].
  18. Yang J, Xue W, Yu X. Elizabethkingia meningosepticum endocarditis: A rare case and special therapy. Anatol J Cardiol. 2015;15(5):427-8. doi: 10.5152/akd.2015.6014. [PubMed: 25993718]. [PubMed Central: PMC5779184].
  19. Yue D, Song C, Zhang B, Liu Z, Chai J, Luo Y, et al. Hospital-wide comparison of health care-associated infection among 8 intensive care units: A retrospective analysis for 2010-2015. Am J Infect Control. 2017;45(1):e7-13. doi: 10.1016/j.ajic.2016.10.011. [PubMed: 27856076].
  20. Wang M, Wei H, Zhao Y, Shang L, Di L, Lyu C, et al. Analysis of multidrug-resistant bacteria in 3223 patients with hospital-acquired infections (HAI) from a tertiary general hospital in China. Bosn J Basic Med Sci. 2019;19(1):86-93. doi: 10.17305/bjbms.2018.3826. [PubMed: 30579325]. [PubMed Central: PMC6387671].