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Maraki S, Katzilakis N, Neonakis I, Stafylaki D, Mavromanolaki VE, Kyriakidis I, Pelagiadis I, Stiakaki E. Central Line-Associated Bloodstream Infection Due to Elizabethkingia anophelis: Case Report and Literature Review on Pediatric Infections. Microorganisms 2024; 12:1145. [PMID: 38930527 PMCID: PMC11205794 DOI: 10.3390/microorganisms12061145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2024] [Revised: 04/13/2024] [Accepted: 06/03/2024] [Indexed: 06/28/2024] Open
Abstract
Elizabethkingia anophelis is an opportunistic pathogen causing lifethreatening infections in humans, particularly in immunocompromised patients, neonates and the elderly. We report a case of central line-associated bloodstream infection by E. anophelis in a 2.5-year-old girl with acute lymphoblastic leukemia successfully treated with a combination of piperacillin/tazobactam and amikacin. The literature was also reviewed on pediatric infections caused by E. anophelis, focusing on clinical manifestations, underlying medical conditions, treatment and outcome. Accurate identification with MALDI-TOF, or using molecular techniques, is of the utmost importance because treatment and prognosis differ depending on the species. Considering that E. anophelis is multiresistant to antibiotics and that inappropriate antimicrobial therapy is an independent risk factor for mortality, the early, accurate identification of bacterial species and prompt effective treatment are essential to achieve optimal therapeutic outcomes.
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Affiliation(s)
- Sofia Maraki
- Department of Clinical Microbiology and Microbial Pathogenesis, University Hospital of Heraklion, 71110 Heraklion, Greece; (S.M.); (I.N.)
| | - Nikolaos Katzilakis
- Department of Pediatric Hematology-Oncology, Laboratory of Blood Diseases and Childhood Cancer Biology, University Hospital of Heraklion, Medical School, University of Crete, 71003 Heraklion, Greece; (I.K.); (I.P.); (E.S.)
| | - Ioannis Neonakis
- Department of Clinical Microbiology and Microbial Pathogenesis, University Hospital of Heraklion, 71110 Heraklion, Greece; (S.M.); (I.N.)
| | - Dimitra Stafylaki
- Department of Pediatrics, Agios Nikolaos General Hospital, 72100 Agios Nikolaos, Greece; (D.S.); (V.E.M.)
| | | | - Ioannis Kyriakidis
- Department of Pediatric Hematology-Oncology, Laboratory of Blood Diseases and Childhood Cancer Biology, University Hospital of Heraklion, Medical School, University of Crete, 71003 Heraklion, Greece; (I.K.); (I.P.); (E.S.)
| | - Iordanis Pelagiadis
- Department of Pediatric Hematology-Oncology, Laboratory of Blood Diseases and Childhood Cancer Biology, University Hospital of Heraklion, Medical School, University of Crete, 71003 Heraklion, Greece; (I.K.); (I.P.); (E.S.)
| | - Eftichia Stiakaki
- Department of Pediatric Hematology-Oncology, Laboratory of Blood Diseases and Childhood Cancer Biology, University Hospital of Heraklion, Medical School, University of Crete, 71003 Heraklion, Greece; (I.K.); (I.P.); (E.S.)
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Brandsema BR, Fleurke GJ, Rosema S, Schins EM, Helfferich J, Bathoorn E. Neonatal Elizabethkingia anophelis meningitis originating from the water reservoir of an automated infant milk dispenser, the Netherlands, February 2024. Euro Surveill 2024; 29:2400177. [PMID: 38577802 PMCID: PMC11004591 DOI: 10.2807/1560-7917.es.2024.29.14.2400177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2024] [Accepted: 04/04/2024] [Indexed: 04/06/2024] Open
Abstract
Elizabethkingia anophelis is a multidrug-resistant pathogen causing high mortality and morbidity in adults with comorbidities and neonates. We report a Dutch case of E. anophelis meningitis in a neonate, clonally related to samples taken from an automated infant milk dispenser located at the family's residence. We inform about the emergence of E. anophelis and suggest molecular surveillance in hospitals and other health settings. This is the first case connecting an automated formula dispenser to an invasive infection in a neonate.
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Affiliation(s)
- B Ruben Brandsema
- University Medical Center Groningen, Department of Paediatric Infectious Diseases and Immunity, Groningen, the Netherlands
- These authors contributed equally to this work and share first/last authorship
| | - Ger-Jan Fleurke
- University Medical Center Groningen, Department of Medical Microbiology, Groningen, the Netherlands
| | - Sigrid Rosema
- University Medical Center Groningen, Department of Medical Microbiology, Groningen, the Netherlands
| | - Eke Mw Schins
- University Medical Center Groningen, Department of Neonatology, Groningen, the Netherlands
| | - Jelte Helfferich
- University Medical Center Groningen, Department of Neurology, Groningen, the Netherlands
| | - Erik Bathoorn
- University Medical Center Groningen, Department of Medical Microbiology, Groningen, the Netherlands
- These authors contributed equally to this work and share first/last authorship
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Rodríguez-Temporal D, García-Cañada JE, Candela A, Oteo-Iglesias J, Serrano-Lobo J, Pérez-Vázquez M, Rodríguez-Sánchez B, Cercenado E. Characterization of an outbreak caused by Elizabethkingia miricola using Fourier-transform infrared (FTIR) spectroscopy. Eur J Clin Microbiol Infect Dis 2024; 43:797-803. [PMID: 38356016 DOI: 10.1007/s10096-024-04764-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Accepted: 01/14/2024] [Indexed: 02/16/2024]
Abstract
Fourier-transform infrared (FTIR) spectroscopy has the potential to be used for bacterial typing and outbreak characterization. We evaluated FTIR for the characterization of an outbreak caused by Elizabethkingia miricola. During the 2020-2021 period, 26 isolates (23 clinical and 3 environmental) were collected and analyzed by FTIR (IR Biotyper) and core-genome MLST (cgMLST), in addition to antimicrobial susceptibility testing. FTIR spectroscopy and cgMLST showed that 22 of the isolates were related to the outbreak, including the environmental samples, with only one discordance between both methods. Then, FTIR is useful for E. miricola typing and can be easily implemented in the laboratory.
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Affiliation(s)
- David Rodríguez-Temporal
- Clinical Microbiology and Infectious Diseases Department, Hospital General Universitario Gregorio Marañón, Doctor Esquerdo, 46, 28007, Madrid, Spain.
- Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain.
| | - Javier Enrique García-Cañada
- Laboratorio de Referencia e Investigación en Resistencia a Antibióticos, Centro Nacional de Microbiología, ISCIII, Majadahonda, Spain
- CIBER de Enfermedades Infecciosas (CIBERINFEC), Madrid, Spain
| | - Ana Candela
- Clinical Microbiology and Infectious Diseases Department, Hospital General Universitario Gregorio Marañón, Doctor Esquerdo, 46, 28007, Madrid, Spain
- Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain
| | - Jesús Oteo-Iglesias
- Laboratorio de Referencia e Investigación en Resistencia a Antibióticos, Centro Nacional de Microbiología, ISCIII, Majadahonda, Spain
- CIBER de Enfermedades Infecciosas (CIBERINFEC), Madrid, Spain
| | - Julia Serrano-Lobo
- Clinical Microbiology and Infectious Diseases Department, Hospital General Universitario Gregorio Marañón, Doctor Esquerdo, 46, 28007, Madrid, Spain
| | - María Pérez-Vázquez
- Laboratorio de Referencia e Investigación en Resistencia a Antibióticos, Centro Nacional de Microbiología, ISCIII, Majadahonda, Spain
- CIBER de Enfermedades Infecciosas (CIBERINFEC), Madrid, Spain
| | - Belén Rodríguez-Sánchez
- Clinical Microbiology and Infectious Diseases Department, Hospital General Universitario Gregorio Marañón, Doctor Esquerdo, 46, 28007, Madrid, Spain
- Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain
| | - Emilia Cercenado
- Clinical Microbiology and Infectious Diseases Department, Hospital General Universitario Gregorio Marañón, Doctor Esquerdo, 46, 28007, Madrid, Spain
- Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain
- CIBER de Enfermedades Respiratorias (CIBERES), Madrid, Spain
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Wang Y, Sapula SA, Whittall JJ, Blaikie JM, Lomovskaya O, Venter H. Identification and characterization of CIM-1, a carbapenemase that adds to the family of resistance factors against last resort antibiotics. Commun Biol 2024; 7:282. [PMID: 38454015 PMCID: PMC10920655 DOI: 10.1038/s42003-024-05940-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Accepted: 02/20/2024] [Indexed: 03/09/2024] Open
Abstract
The increasing rate of carbapenem-resistant bacteria within healthcare environments is an issue of great concern that needs urgent attention. This resistance is driven by metallo-β-lactamases (MBLs), which can catalyse the hydrolysis of almost all clinically available β-lactams and are resistant to all the clinically utilized β-lactamase inhibitors. In this study, an uncharacterized MBL is identified in a multidrug resistant isolate of the opportunistic pathogen, Chryseobacterium indologenes. Sequence analysis predicts this MBL (CIM-1) to be a lipoprotein with an atypical lipobox. Characterization of CIM-1 reveals it to be a high-affinity carbapenemase with a broad spectrum of activity that includes all cephalosporins and carbapenems. Results also shown that CIM-1 is potentially a membrane-associated MBL with an uncharacterized lipobox. Using prediction tools, we also identify more potentially lipidated MBLs with non-canonical lipoboxes highlighting the necessity of further investigation of lipidated MBLs.
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Affiliation(s)
- Yu Wang
- Health and Biomedical Innovation, Clinical and Health Sciences, University of South Australia, Adelaide, Australia
- School of Biomedical Science, University of Adelaide, Adelaide, Australia
| | - Sylvia A Sapula
- Health and Biomedical Innovation, Clinical and Health Sciences, University of South Australia, Adelaide, Australia
| | - Jonathan J Whittall
- Health and Biomedical Innovation, Clinical and Health Sciences, University of South Australia, Adelaide, Australia
| | - Jack M Blaikie
- Health and Biomedical Innovation, Clinical and Health Sciences, University of South Australia, Adelaide, Australia
| | | | - Henrietta Venter
- Health and Biomedical Innovation, Clinical and Health Sciences, University of South Australia, Adelaide, Australia.
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Lee YL, Hsueh PR. Emerging infections in vulnerable hosts: Stenotrophomonas maltophilia and Elizabethkingia anophelis. Curr Opin Infect Dis 2023; 36:481-494. [PMID: 37548375 DOI: 10.1097/qco.0000000000000953] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/08/2023]
Abstract
PURPOSE OF REVIEW This systematic review aimed to explore the recent trends in the epidemiology, risk factors, and antimicrobial susceptibility of two emerging opportunistic pathogens, Stenotrophomonas maltophilia and Elizabethkingia anophelis . RECENT FINDINGS Since 2020, numerous outbreaks of S. maltophilia and E. anophelis have been reported worldwide. Most of these outbreaks have been associated with healthcare facilities, although one outbreak caused by E. anophelis in France was considered a community-associated infection. In terms of antimicrobial susceptibility, trimethoprim/sulfamethoxazole (TMP-SMZ), levofloxacin, and minocycline have exhibited good efficacy against S. maltophilia . Additionally, cefiderocol and a combination of aztreonam and avibactam have shown promising results in in vitro susceptibility testing. For E. anophelis , there is currently no consensus on the optimal treatment. Although some studies have reported good efficacy with rifampin, TMP-SMZ, piperacillin/tazobactam, and cefoperazone/sulbactam, minocycline had the most favourable in vitro susceptibility rates. Cefiderocol may serve as an alternative due to its low minimum inhibitory concentration (MIC) against E. anophelis . The role of vancomycin in treatment is still uncertain, although several successful cases with vancomycin treatment, even with high MIC values, have been reported. SUMMARY Immunocompromised patients are particularly vulnerable to infections caused by S. maltophilia and E. anophelis , but the optimal treatment strategy remains inconclusive. Further research is necessary to determine the most effective use of conventional and novel antimicrobial agents in combatting these multidrug-resistant pathogens.
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Affiliation(s)
- Yu-Lin Lee
- Department of Internal Medicine, Chung Shan Medical University Hospital
- School of Medicine, Chung Shan Medical University
- PhD Program in Medical Biotechnology, National Chung-Hsing University
| | - Po-Ren Hsueh
- Departments of Laboratory Medicine and Internal Medicine, China Medical University Hospital
- School of Medicine
- PhD Program for Aging, School of Medicine, China Medical University, Taichung
- Departments of Laboratory Medicine and Internal Medicine, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan
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Mallinckrodt L, Huis In 't Veld R, Rosema S, Voss A, Bathoorn E. Review on infection control strategies to minimize outbreaks of the emerging pathogen Elizabethkingia anophelis. Antimicrob Resist Infect Control 2023; 12:97. [PMID: 37679842 PMCID: PMC10486102 DOI: 10.1186/s13756-023-01304-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Accepted: 09/01/2023] [Indexed: 09/09/2023] Open
Abstract
BACKGROUND Elizabethkingia anophelis is a multi-drug resistant emerging opportunistic pathogen with a high mortality rate, causing healthcare-associated outbreaks worldwide. METHODS We report a case of E. anophelis pleuritis, resulting from transmission through lung transplantation, followed by a literature review of outbreak reports and strategies to minimize E. anophelis transmission in healthcare settings. RESULTS From 1990 to August 2022, 14 confirmed E. anophelis outbreak cohorts and 21 cohorts with suspected E. anophelis outbreaks were reported in literature. A total of 80 scientific reports with recommendations on diagnostics and infection control measures were included and summarized in our study. CONCLUSION Strategies to prevent and reduce spread of E. anophelis include water-free patient rooms, adequate hygiene and disinfection practices, and optimized diagnostic techniques for screening, identification and molecular typing.
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Affiliation(s)
- Lisa Mallinckrodt
- Department of Medical Microbiology and Infection Prevention, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
- Department of Medical Microbiology and Infection Prevention, Gelre Hospital, Apeldoorn, The Netherlands
| | - Robert Huis In 't Veld
- Department of Medical Microbiology and Infection Prevention, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Sigrid Rosema
- Department of Medical Microbiology and Infection Prevention, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Andreas Voss
- Department of Medical Microbiology and Infection Prevention, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Erik Bathoorn
- Department of Medical Microbiology and Infection Prevention, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.
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Chaudhary S, Rijal A, Rajbhandari P, Acharya AB. The First Reported Case of Elizabethkingia anophelis From Nepal. Cureus 2023; 15:e45346. [PMID: 37849601 PMCID: PMC10577804 DOI: 10.7759/cureus.45346] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/16/2023] [Indexed: 10/19/2023] Open
Abstract
Elizabethkingia anophelis, a gram-negative bacillus belonging to the Flavobacteriaceae family, is found in various environmental sources and has been associated with community and hospital outbreaks. Correct identification is crucial, guided by advanced genomic techniques, i.e., matrix-assisted laser desorption ionization-time of flight mass spectrometry (MALDI-TOF MS) system with an updated database. The case fatality rate, ranging from 24 to 60%, underscores the need for timely recognition and appropriate management. Additionally, Elizabethkingia presents a challenge due to its recent discovery, misidentification history, and drug resistance. Here, we present a case of fatal infection in a 30-year-old male, who presented with pneumonia. It gradually progressed and ultimately proved fatal underscoring the virulence of the pathogen involved. It was a diagnostic challenge as it likely is the first reported instance of Elizabethkingia anophelis infection from Nepal.
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Affiliation(s)
- Sharmila Chaudhary
- Critical Care Medicine, Patan Academy of Health Sciences, Kathmandu, NPL
| | - Ashes Rijal
- Anesthesiology and Critical Care, Institute of Medicine, Tribhuvan University Teaching Hospital, Kathmandu, NPL
- Public Health Sciences, Nepal Health Frontiers, Kathmandu, NPL
| | | | - Achyut Bhakta Acharya
- Pulmonary, Critical Care & Sleep Medicine, B.P. Koirala Institute of Health Sciences, Dharan, NPL
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