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Huang C, Kuo S, Lin L. Mortality Risk and Antibiotic Therapy for Patients with Infections Caused by Elizabethkingia Species-A Meta-Analysis. MEDICINA (KAUNAS, LITHUANIA) 2024; 60:1529. [PMID: 39336571 PMCID: PMC11433677 DOI: 10.3390/medicina60091529] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/08/2024] [Revised: 09/10/2024] [Accepted: 09/14/2024] [Indexed: 09/30/2024]
Abstract
Background and Objectives: Patients with infections caused by Elizabethkingia species require prompt identification and effective antibiotic treatment since these spp. are typically resistant to multiple antibiotics and variable susceptibility patterns. Understanding the mortality risk of this disease is difficult because of the relatively low incidence of infections caused by Elizabethkingia spp. and the lack of published systematic evaluations of the risk factors for mortality. The aim of the present study was to investigate risk factors for mortality in patients with infections caused by Elizabethkingia spp. by conducting a meta-analysis of existing studies on these infections. Materials and Methods: Studies comparing patients who died from infections caused by Elizabethkingia spp. with patients who survived were considered for inclusion. Studies that reported one or more risk factors for mortality were considered. Clinical predisposing variables, predisposing comorbidities, and clinical outcomes of antibiotic treatment were among the risk factors for mortality. Results: The meta-analysis included twenty studies with 990 patients, and 298 patients (30.1%) died. The following risk factors for mortality were identified: intensive care unit admission, the need for mechanical ventilation, immunosuppressive or steroid therapy use, pneumonia, comorbid liver disease, and the use of inappropriate antimicrobial therapy. Conclusions: The use of appropriate antimicrobial therapy is critical for the effective management of infections caused by Elizabethkingia spp. Antimicrobial susceptibility testing would be a more reliable means of guiding treatment. The identification of the best antimicrobial drugs is needed to ensure optimal treatment recommendations for treating Elizabethkingia-related infections.
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Affiliation(s)
- Chienhsiu Huang
- Department of Internal Medicine, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, No. 2, Min-Sheng Road, Dalin Town, Chiayi 62247, Taiwan
| | - Sufang Kuo
- Department of Nursing, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, No. 2, Min-Sheng Road, Dalin Town, Chiayi 62247, Taiwan; (S.K.); (L.L.)
| | - Lichen Lin
- Department of Nursing, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, No. 2, Min-Sheng Road, Dalin Town, Chiayi 62247, Taiwan; (S.K.); (L.L.)
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Feng M, Huang M, Fan Y, Liu G, Zhou S, Zhou J. Clinical Characteristics and Risk Factors for Infection and Death in Critically Ill Patients with Pulmonary Infection with Elizabethkingia Spp. Infect Drug Resist 2024; 17:2673-2683. [PMID: 38953097 PMCID: PMC11216603 DOI: 10.2147/idr.s460640] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2024] [Accepted: 06/24/2024] [Indexed: 07/03/2024] Open
Abstract
Purpose Elizabethkingia spp. infections have recently increased, and they are difficult to treat because of intrinsic antimicrobial resistance. This study aimed to investigate the clinical characteristics of patients with pulmonary infection with Elizabethkingia spp. and reveal the risk factors for infection and death. Patients and Methods In this retrospective case-control study, patients were divided into infection and control groups based on the bacterial identification results. Patients in the infection group were further divided into survival and death groups according to their hospital outcomes. Clinical characteristics between different groups were compared. We further analyzed antimicrobial susceptibility testing results of the isolated strains. Results A total of the 316 patients were divided into infection (n = 79), 23 of whom died, and control (n = 237) groups. Multivariate logistic regression analysis showed that glucocorticoid consumption (OR: 2.35; 95% CI: 1.14-4.81; P = 0.02), endotracheal intubation (OR: 3.74; 95% CI: 1.62-8.64; P = 0.002), and colistin exposure (OR: 2.50; 95% CI: 1.01-6.29; P = 0.046) were significantly associated with pulmonary infection with Elizabethkingia spp. Advanced age (OR: 1.07, 95% CI: 1.00-1.15; P = 0.046), high acute physiology and chronic health evaluation (APACHE) II score (OR: 1.21; 95% CI: 1.01-1.45; P = 0.037), and low albumin level (OR: 0.73, 95% CI: 0.56-0.96; P = 0.025) were significantly associated with in-hospital mortality of infected patients. Elizabethkingia spp. was highly resistant to cephalosporins, carbapenems, macrolides, and aminoglycoside, and was sensitive to fluoroquinolones, minocycline, and co-trimoxazole in vitro. Conclusion Glucocorticoid consumption, tracheal intubation, and colistin exposure were associated with pulmonary infection with Elizabethkingia spp. for critically ill patients. Patients with advanced age, high APACHE II score, and low albumin level had higher risk of death from infection.
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Affiliation(s)
- Mengwen Feng
- Department of Critical Care Medicine, the First Affiliated Hospital of Nanjing Medical University, Nanjing, People’s Republic of China
| | - Min Huang
- Department of Geriatric Intensive Care Medicine, the First Affiliated Hospital of Nanjing Medical University, Nanjing, People’s Republic of China
| | - Yuanyuan Fan
- Department of Critical Care Medicine, the First Affiliated Hospital of Nanjing Medical University, Nanjing, People’s Republic of China
| | - Genyan Liu
- Department of Laboratory Medicine, the First Affiliated Hospital of Nanjing Medical University, Nanjing, People’s Republic of China
| | - Suming Zhou
- Department of Geriatric Intensive Care Medicine, the First Affiliated Hospital of Nanjing Medical University, Nanjing, People’s Republic of China
| | - Jing Zhou
- Department of Geriatric Intensive Care Medicine, the First Affiliated Hospital of Nanjing Medical University, Nanjing, People’s Republic of China
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Wu C, Xiong L, Liao Q, Zhang W, Xiao Y, Xie Y. Clinical manifestations, antimicrobial resistance and genomic feature analysis of multidrug-resistant Elizabethkingia strains. Ann Clin Microbiol Antimicrob 2024; 23:32. [PMID: 38600542 PMCID: PMC11007976 DOI: 10.1186/s12941-024-00691-6] [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: 06/13/2023] [Accepted: 03/26/2024] [Indexed: 04/12/2024] Open
Abstract
BACKGROUND Elizabethkingia is emerging as an opportunistic pathogen in humans. The aim of this study was to investigate the clinical epidemiology, antimicrobial susceptibility, virulence factors, and genome features of Elizabethkingia spp. METHODS Clinical data from 71 patients who were diagnosed with Elizabethkingia-induced pneumonia and bacteremia between August 2019 and September 2021 were analyzed. Whole-genome sequencing was performed on seven isolates, and the results were compared with a dataset of 83 available Elizabethkingia genomes. Genomic features, Kyoto Encyclopedia of Genes and Genomes (KEGG) results and clusters of orthologous groups (COGs) were analyzed. RESULTS The mean age of the patients was 56.9 ± 20.7 years, and the in-hospital mortality rate was 29.6% (21/71). Elizabethkingia strains were obtained mainly from intensive care units (36.6%, 26/71) and emergency departments (32.4%, 23/71). The majority of the strains were isolated from respiratory tract specimens (85.9%, 61/71). All patients had a history of broad-spectrum antimicrobial exposure. Hospitalization for invasive mechanical ventilation or catheter insertion was found to be a risk factor for infection. The isolates displayed a high rate of resistance to cephalosporins and carbapenems, but all were susceptible to minocycline and colistin. Genomic analysis identified five β-lactamase genes (blaGOB, blaBlaB, blaCME, blaOXA, and blaTEM) responsible for β-lactam resistance and virulence genes involved in stress adaptation (ureB/G, katA/B, and clpP), adherence (groEL, tufA, and htpB) and immune modulation (gmd, tviB, cps4J, wbtIL, cap8E/D/G, and rfbC). Functional analysis of the COGs revealed that "metabolism" constituted the largest category within the core genome, while "information storage and processing" was predominant in both the accessory and unique genomes. The unique genes in our 7 strains were mostly enriched in KEGG pathways related to microRNAs in cancer, drug resistance (β-lactam and vancomycin), ABC transporters, biological metabolism and biosynthesis, and nucleotide excision repair mechanisms. CONCLUSION The Elizabethkingia genus exhibits multidrug resistance and carries carbapenemase genes. This study presents a comparative genomic analysis of Elizabethkingia, providing knowledge that facilitates a better understanding of this microorganism.
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Affiliation(s)
- Chongyang Wu
- Department of Laboratory Medicine, West China Hospital of Sichuan University, Chengdu, Sichuan, 610041, China
| | - Li Xiong
- Department of Laboratory Medicine, West China Hospital of Sichuan University, Chengdu, Sichuan, 610041, China
| | - Quanfeng Liao
- Department of Laboratory Medicine, West China Hospital of Sichuan University, Chengdu, Sichuan, 610041, China
| | - Weili Zhang
- Department of Laboratory Medicine, West China Hospital of Sichuan University, Chengdu, Sichuan, 610041, China
| | - Yuling Xiao
- Department of Laboratory Medicine, West China Hospital of Sichuan University, Chengdu, Sichuan, 610041, China
| | - Yi Xie
- Department of Laboratory Medicine, West China Hospital of Sichuan University, Chengdu, Sichuan, 610041, China.
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Liu SH, Chen YY, Nurmatov U, van Schayck OCP, Kuo IC. Antibiotics Versus Placebo for Acute Bacterial Conjunctivitis: Findings From a Cochrane Systematic Review. Am J Ophthalmol 2024; 257:143-153. [PMID: 37482371 PMCID: PMC10799969 DOI: 10.1016/j.ajo.2023.06.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Revised: 06/28/2023] [Accepted: 06/30/2023] [Indexed: 07/25/2023]
Abstract
PURPOSE To summarize key findings from a Cochrane review of the benefits and safety of antibiotic therapy compared with placebo (or vehicle) for acute bacterial conjunctivitis. DESIGN Systematic review and meta-analysis. METHODS We included placebo-controlled randomized controlled trials (RCTs) that compared topical antibiotics with placebo. We followed Cochrane methods for trial selection, data extraction, risk of bias assessment, and evidence synthesis. RESULTS Twenty-one RCTs involving 8805 participants with acute bacterial conjunctivitis were included. Fifteen (71%) RCTs examined fluoroquinolone (FQ) drops, 3 tested macrolides, alone or in combination with steroids, and another 3 compared other non-FQ antibiotics. Intention-to-treat estimates suggested that compared with placebo, antibiotics may increase clinical recovery by 26% (risk ratio [RR]: 1.26; 95% confidence interval [CI]: 1.09-1.46) at the end of therapy (5 RCTs, 1474 participants). Modified intention-to-treat estimates, in which only participants with laboratory-confirmed bacterial conjunctivitis were analyzed, indicated that antibiotics were associated with 53% higher likelihood of microbiological cure as compared with placebo (RR: 1.53; 95% CI: 1.34-1.74; 10 RCTs, 2827 participants). Non-FQs (RR: 4.05; 95% CI: 1.36-12.00), but not FQs (RR: 0.70; 95% CI: 0.54-0.90), were likely to increase treatment-associated ocular complications such as eye pain, discomfort, and allergic reactions; the certainty of level of evidence was very low. CONCLUSIONS Moderate level certainty of evidence suggested that antibiotics may increase the likelihood of clinical recovery and microbiological clearance compared with placebo. Very low-level certainty of evidence suggested that antibiotics may be associated with potential harm in patients with acute bacterial conjunctivitis, but the potential risk of bias from study design, inconsistency in outcome measurement, and reporting limit the evidence to very low certainty.
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Affiliation(s)
- Su-Hsun Liu
- From the Department of Ophthalmology, School of Medicine (S.-H.L.); Department of Epidemiology, School of Public Health (S.-H.L.), University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Yu-Yen Chen
- Department of Ophthalmology, Taichung Veterans General Hospital, Taichung, Taiwan (Y.-Y.C.); Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA (Y.-Y.C., I.C.K.); School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan (Y.-Y.C.)
| | - Ulugbek Nurmatov
- Division of Population Medicine, School of Medicine, the National Centre for Population Health and Wellbeing Research, Cardiff University, Cardiff, UK (U.N.)
| | - Onno C P van Schayck
- Department of Family Medicine, Maastricht University (CAPHRI), Maastricht, the Netherlands (O.C.P.V.S)
| | - Irene C Kuo
- Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA (Y.-Y.C., I.C.K.).
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Hu S, Chen Y, Xu H, Chen J, Hu S, Meng X, Ni S, Xiao Y, Zheng B. Probability of outbreaks and cross-border dissemination of the emerging pathogen: a genomic survey of Elizabethkingia meningoseptica. Microbiol Spectr 2023; 11:e0160223. [PMID: 37815354 PMCID: PMC10714787 DOI: 10.1128/spectrum.01602-23] [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: 04/16/2023] [Accepted: 08/14/2023] [Indexed: 10/11/2023] Open
Abstract
IMPORTANCE Elizabethkingia meningoseptica is an emerging infectious agent associated with life-threatening infections in immunocompromised individuals. However, there are limited data available on the genomic features of E. meningoseptica. This study aims to characterize the geographical distribution, phylogenetic evolution, pathogenesis, and transmission of this bacterium. A systematic analysis of the E. meningoseptica genome revealed that a common ancestor of this bacterium existed 90 years ago. The evolutionary history showed no significant relationship with the sample source, origin, or region, despite the presence of genetic diversity. Whole genome sequencing data also demonstrated that E. meningoseptica bacteria possess inherent resistance and pathogenicity, enabling them to spread within the same hospital and even across borders. This study highlights the potential for E. meningoseptica to cause severe nosocomial outbreaks and horizontal transmission between countries worldwide. The available evidence is crucial for the development of evidence-based public health policies to prevent global outbreaks caused by emerging pathogens.
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Affiliation(s)
- Shaohua Hu
- State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, National Clinical Research Center for Infectious Diseases, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Yingying Chen
- Department of Neurosurgery, Shaoxing People's Hospital (Shaoxing Hospital, Zhejiang University School of Medicine), Shaoxing, Zhejiang, China
| | - Hao Xu
- State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, National Clinical Research Center for Infectious Diseases, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Jing Chen
- Data Resource Development Department, Hangzhou Matridx Biotechnology Co., Ltd., Hangzhou, Zhejiang, China
| | - Shaojun Hu
- Department of Pathology, Zhejiang Provincial Hospital of Chinese Medicine, Hangzhou, Zhejiang, China
| | - Xiaohua Meng
- State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, National Clinical Research Center for Infectious Diseases, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Shujun Ni
- State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, National Clinical Research Center for Infectious Diseases, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Yonghong Xiao
- State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, National Clinical Research Center for Infectious Diseases, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
- Department of Structure and Morphology, Jinan Microecological Biomedicine Shandong Laboratory, Jinan, Shandong, China
- Research Units of Infectious Diseases and Microecology, Chinese Academy of Medical Sciences, Beijing, Hebei, China
| | - Beiwen Zheng
- State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, National Clinical Research Center for Infectious Diseases, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
- Department of Structure and Morphology, Jinan Microecological Biomedicine Shandong Laboratory, Jinan, Shandong, China
- Research Units of Infectious Diseases and Microecology, Chinese Academy of Medical Sciences, Beijing, Hebei, China
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Tsai MA, See MS, Chiu CH, Wang PC, Chen SC. Genotypic and phenotypic analysis of Elizabethkingia meningoseptica in bullfrog Rana catesbeiana isolated in Taiwan. JOURNAL OF FISH DISEASES 2023; 46:1239-1248. [PMID: 37519120 DOI: 10.1111/jfd.13842] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Revised: 07/17/2023] [Accepted: 07/19/2023] [Indexed: 08/01/2023]
Abstract
Elizabethkingia meningoseptica is a hazardous bacterium for agriculture production and human health. The present study identified E. meningoseptica from the bullfrog, human and reference strain BCRC 10677 by API 20NE, 50S ribosome protein L27 sequencing and pulse field gel electrophoresis to differentiate isolates of E. meningoseptica from aquatic animals and humans. All isolates from bullfrogs and humans were identified as E. meningoseptica by DNA sequencing with 98.8%-100% sequence identity. E. meningoseptica displayed significant genetic diversity when analysed using pulsed-field gel electrophoresis (PFGE). There were six distinct pulsotypes, including one pulsotype found in bullfrog isolates and five pulsotypes found in human isolates. However, E. meningoseptica from bullfrog exhibited one genotype only by PFGE. Overall, molecular epidemiological analysis of PFGE results indicated that the frog E. meningoseptica outbreaks in Taiwan were produced by genetically identical clones. The bullfrog isolates were not genetically related to other E. meningoseptica from human and reference isolates. This research provided the first comparisons of biochemical characteristics and genetic differences of E. meningoseptica from human and bullfrog isolates.
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Affiliation(s)
- Ming-An Tsai
- Department of Veterinary Medicine, College of Veterinary Medicine, National Pingtung University of Science and Technology, Pingtung, Taiwan
- International Program in Ornamental Fish Technology and Aquatic Animal Health, International College, National Pingtung University of Science and Technology, Pingtung, Taiwan
- Southern Taiwan Fish Diseases Research Center, College of Veterinary Medicine, National Pingtung University of Science and Technology, Pingtung, Taiwan
| | - Ming She See
- Faculty of Science and Marine Environment, Universiti Malaysia Terengganu, Kuala Nerus, Terengganu, Malaysia
| | - Cheng-Hsun Chiu
- Division of Pediatric Infectious Diseases, Department of Pediatrics, Chang Gung Children's Hospital, Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Pei-Chi Wang
- Department of Veterinary Medicine, College of Veterinary Medicine, National Pingtung University of Science and Technology, Pingtung, Taiwan
- International Program in Ornamental Fish Technology and Aquatic Animal Health, International College, National Pingtung University of Science and Technology, Pingtung, Taiwan
- Southern Taiwan Fish Diseases Research Center, College of Veterinary Medicine, National Pingtung University of Science and Technology, Pingtung, Taiwan
| | - Shih-Chu Chen
- Department of Veterinary Medicine, College of Veterinary Medicine, National Pingtung University of Science and Technology, Pingtung, Taiwan
- International Program in Ornamental Fish Technology and Aquatic Animal Health, International College, National Pingtung University of Science and Technology, Pingtung, Taiwan
- Southern Taiwan Fish Diseases Research Center, College of Veterinary Medicine, National Pingtung University of Science and Technology, Pingtung, Taiwan
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Lee JW, Sun B, Hanna M, Rihawi A. A Case of Community-Acquired Elizabethkingia meningoseptica. Cureus 2023; 15:e45183. [PMID: 37720113 PMCID: PMC10503884 DOI: 10.7759/cureus.45183] [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: 09/13/2023] [Indexed: 09/19/2023] Open
Abstract
Many nosocomial infections commonly arise as a result of contaminated water sources in the hospital setting, such as sinks, air-conditioning systems, ventilation devices, and catheters. Among the microorganisms found in these environments is Elizabethkingia meningoseptica, a gram-negative bacterium first discovered in 1959 by Elizabeth O. King. This bacterium is a rare cause of meningitis, pneumonia, bacteremia, and skin and soft tissue infections in hospital settings. This case report examines a unique community-acquired transmission of E. meningoseptica in a 78-year-old male patient with an extensive medical history who presented with acute fever and confusion coupled with multiple recent falls. Examination and culturing of an open wound on a dry blister of the left lower extremity revealed the presence of E. meningoseptica.
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Affiliation(s)
- Jae Woo Lee
- Medicine, Trinity School of Medicine, Warner Robins, USA
| | - Bo Sun
- Medicine, Trinity School of Medicine, Warner Robins, USA
| | - Mina Hanna
- Medicine, Trinity School of Medicine, Warner Robins, USA
| | - Ayman Rihawi
- Infectious Diseases, Houston Healthcare, Warner Robins, USA
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Chen YY, Liu SH, Nurmatov U, van Schayck OC, Kuo IC. Antibiotics versus placebo for acute bacterial conjunctivitis. Cochrane Database Syst Rev 2023; 3:CD001211. [PMID: 36912752 PMCID: PMC10014114 DOI: 10.1002/14651858.cd001211.pub4] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/14/2023]
Abstract
BACKGROUND Acute bacterial conjunctivitis is an infection of the conjunctiva and is one of the most common ocular disorders in primary care. Antibiotics are generally prescribed on the basis that they may speed recovery, reduce persistence, and prevent keratitis. However, many cases of acute bacterial conjunctivitis are self-limited, resolving without antibiotic therapy. This Cochrane Review was first published in The Cochrane Library in 1999, then updated in 2006, 2012, and 2022. OBJECTIVES To assess the benefits and side effects of antibiotic therapy in the management of acute bacterial conjunctivitis. SEARCH METHODS We searched CENTRAL (which contains the Cochrane Eyes and Vision Group Trials Register) (The Cochrane Library 2022, Issue 5), MEDLINE (January 1950 to May 2022), Embase (January 1980 to May 2022), the metaRegister of Controlled Trials (mRCT) (www.controlled-trials.com), ClinicalTrials.gov (www. CLINICALTRIALS gov), and the WHO International Clinical Trials Registry Platform (ICTRP) (www.who.int/ictrp/search/en). We did not use any date or language restrictions in the electronic searches for trials. We last searched the electronic databases in May 2022. SELECTION CRITERIA: We included randomized controlled trials (RCTs) in which any form of antibiotic treatment, with or without steroid, had been compared with placebo/vehicle in the management of acute bacterial conjunctivitis. This included topical and systemic antibiotic treatments. DATA COLLECTION AND ANALYSIS Two authors independently reviewed the titles and abstracts of identified studies. We assessed the full text of all potentially relevant studies and determined the included RCTs, which were further assessed for risk of bias using Cochrane methodology. We performed data extraction in a standardized manner and conducted random-effects meta-analyses using RevMan Web. MAIN RESULTS We included 21 eligible RCTs, 10 of which were newly identified in this update. A total of 8805 participants were randomized. All treatments were topical in the form of drops or ointment. The trials were heterogeneous in terms of their eligibility criteria, the nature of the intervention (antibiotic drug class, which included fluoroquinolones [FQs] and non-FQs; dosage frequency; duration of treatment), the outcomes assessed and the time points of assessment. We judged one trial to be of high risk of bias, four as low risk of bias, and the others as raising some concerns. Based on intention-to-treat (ITT) population, antibiotics likely improved clinical cure (resolution of clinical symptoms or signs) by 26% (RR 1.26, 95% CI 1.09 to 1.46; 5 trials, 1474 participants; moderate certainty) as compared with placebo. Subgroup analysis showed no differences by antibiotic class (P = 0.67) or treatment duration (P = 0.60). In the placebo group, 55.5% (408/735) of participants had spontaneous clinical resolution by days 4 to 9 versus 68.2% (504/739) of participants treated with an antibiotic. Based on modified ITT population, in which participants were analyzed after randomization on the basis of positive microbiological culture, antibiotics likely increased microbiological cure (RR 1.53, 95% CI 1.34 to 1.74; 10 trials, 2827 participants) compared with placebo at the end of therapy; there were no subgroup differences by drug class (P = 0.60). No study evaluated the cost-effectiveness of antibiotic treatment. Patients receiving antibiotics had a lower risk of treatment incompletion than those in the placebo group (RR 0.64, 95% CI 0.52 to 0.78; 13 trials, 5573 participants; moderate certainty) and were 27% less likely to have persistent clinical infection (RR 0.73, 95% CI 0.65 to 0.81; 19 trials, 5280 participants; moderate certainty). There was no evidence of serious systemic side effects reported in either the antibiotic or placebo group (very low certainty). When compared with placebo, FQs (RR 0.70, 95% CI 0.54 to 0.90) but not non-FQs (RR 4.05, 95% CI 1.36 to 12.00) may result in fewer participants with ocular side effects. However, the estimated effects were of very low certainty. AUTHORS' CONCLUSIONS The findings of this update suggest that the use of topical antibiotics is associated with a modestly improved chance of resolution in comparison to the use of placebo. Since no evidence of serious side effects was reported, use of antibiotics may therefore be considered to achieve better clinical and microbiologic efficacy than placebo. Increasing the proportion of participants with clinical cure or increasing the speed of recovery or both are important for individual return to work or school, allowing people to regain quality of life. Future studies may examine antiseptic treatments with topical antibiotics for reasons of cost and growing antibiotic resistance.
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Affiliation(s)
- Yu-Yen Chen
- Department of Ophthalmology, Taichung Veterans General Hospital, Taichung, Taiwan
- Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
- School of Medicine, Chung Shan Medical University, Taichung, Taiwan
- Department of Post-Baccalaureate Medicine, College of Medicine, National Chung Hsing University, Taichung, Taiwan
| | - Su-Hsun Liu
- Department of Ophthalmology, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
- Department of Epidemiology, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Ulugbek Nurmatov
- Division of Population Medicine, School of Medicine, the National Centre for Population Health and Wellbeing Research, Cardiff University, Cardiff, UK
| | - Onno Cp van Schayck
- Department of Family Medicine, Maastricht University (CAPHRI), Maastricht, Netherlands
| | - Irene C Kuo
- Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
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Ma S, Gong Y, Luo X, Peng Y, Zhang C, Zhang X, Hu X, Tang P, Yuan Z, Luo G, Li H. Emerging Prevalence and Clinical Features of Elizabethkingia meningoseptica Infection in Southwest China: A 9-Year Retrospective Study and Systematic Review. Infect Drug Resist 2023; 16:531-543. [PMID: 36721634 PMCID: PMC9884462 DOI: 10.2147/idr.s397051] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Accepted: 01/06/2023] [Indexed: 01/26/2023] Open
Abstract
Background Elizabethkingia meningoseptica infections have gradually emerged as life-threatening nosocomial infections worldwide, accompanied by increasing incidence, multidrug resistance and poor outcomes. However, the epidemiology and clinical features of E. meningoseptica infection are still limited in mainland China. Methods Patients with E. meningoseptica infections from 2011 to 2019 in southwestern China were retrospectively analyzed. The clinical features, infection patterns and outcomes were extracted from medical records and analyzed. A comprehensive systematic review was performed in accordance with PRISMA guidelines from conception to August 23, 2021. Results Ninety-two patients were ultimately included, with the prevalence rapidly rising from 0 in 2011 to 0.19 per 1000 inpatients in 2019. A total of 93.48% of E. meningoseptica isolates were multidrug resistant, including 100% resistance to carbapenem. Furthermore, 75% of E. meningoseptica infections were concomitant with other pathogens. The mortality of our cohort was 36.96%, with risk factors for mechanical ventilation (OR=9.51, P=0.004), male sex (OR=0.27, P=0.031) and more concomitant pathogens. After propensity score matching, central venous catheters, exposure to carbapenem and antifungal drugs, and underlying tumors were associated with E. meningoseptica infection. Sixteen articles were also summarized, with reported mortality rates ranging from 11.0% to 66.6%. Blood and respiratory tract were the common sources. Piperacillin/tazobactam, trimethoprim/sulfamethoxazole, fluoroquinolone and minocycline were the most sensitive antibiotics. Inappropriate antibiotic treatment was the most commonly reported risk factor for mortality. Conclusion Nosocomial infection with E. meningoseptica has become an emerging problem with high mortality in southwestern China. Inappropriate antibiotic treatment and central venous catheters are risk factors for infection and death and should receive adequate attention.
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Affiliation(s)
- Siyuan Ma
- State Key Laboratory of Trauma, Burns and Combined Injury, Chongqing Key Laboratory for Proteomics Disease, Institute of Burn Research, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, People’s Republic of China
| | - Yali Gong
- State Key Laboratory of Trauma, Burns and Combined Injury, Chongqing Key Laboratory for Proteomics Disease, Institute of Burn Research, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, People’s Republic of China
| | - Xiaoqiang Luo
- State Key Laboratory of Trauma, Burns and Combined Injury, Chongqing Key Laboratory for Proteomics Disease, Institute of Burn Research, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, People’s Republic of China
| | - Yuan Peng
- Department of Plastic and Reconstructive Surgery, Shanghai Ninth People’s Hospital, Shanghai JiaoTong University School of Medicine, Shanghai, People’s Republic of China
| | - Cheng Zhang
- State Key Laboratory of Trauma, Burns and Combined Injury, Chongqing Key Laboratory for Proteomics Disease, Institute of Burn Research, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, People’s Republic of China
| | - Xiaorong Zhang
- State Key Laboratory of Trauma, Burns and Combined Injury, Chongqing Key Laboratory for Proteomics Disease, Institute of Burn Research, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, People’s Republic of China
| | - Xiaohong Hu
- State Key Laboratory of Trauma, Burns and Combined Injury, Chongqing Key Laboratory for Proteomics Disease, Institute of Burn Research, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, People’s Republic of China
| | - Peng Tang
- Department of Clinical Laboratory, the Second Affiliated Hospital of Army Medical University, Chongqing, People’s Republic of China
| | - Zhiqiang Yuan
- State Key Laboratory of Trauma, Burns and Combined Injury, Chongqing Key Laboratory for Proteomics Disease, Institute of Burn Research, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, People’s Republic of China
| | - Gaoxing Luo
- State Key Laboratory of Trauma, Burns and Combined Injury, Chongqing Key Laboratory for Proteomics Disease, Institute of Burn Research, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, People’s Republic of China
| | - Haisheng Li
- State Key Laboratory of Trauma, Burns and Combined Injury, Chongqing Key Laboratory for Proteomics Disease, Institute of Burn Research, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, People’s Republic of China
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10
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Li Y, Liu T, Shi C, Wang B, Li T, Huang Y, Xu Y, Tang L. Epidemiological, clinical, and laboratory features of patients infected with Elizabethkingia meningoseptica at a tertiary hospital in Hefei City, China. Front Public Health 2022; 10:964046. [PMID: 36225778 PMCID: PMC9549487 DOI: 10.3389/fpubh.2022.964046] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Accepted: 08/22/2022] [Indexed: 01/24/2023] Open
Abstract
Background Elizabethkingia meningoseptica is a bacterium causing potential nosocomial infections and is associated with a high mortality rate; however, the date of patients in the Hefei population who have been diagnosed with this infection is generally limited. Purpose The clinical and laboratory data of patients from a tertiary hospital in Hefei City who had E. meningoseptica infection were evaluated in this retrospective analysis. Patients and methods From May 2017 to November 2021, there were 24 patients infected with E. meningoseptica in the First Affiliated Hospital of Anhui Medical University. Data were gathered from the hospital's electronic medical records for all patients. Results The most prevalent symptom among the 24 patients was fever (83.3%), followed by edema (41.7%), cough (37.5%), altered consciousness (41.7%), and sputum (37.5%), and laboratory results presented with anemia (75%), hypoproteinemia (75%), elevated C-reactive protein (CRP) (66.7%), neutrophilia (54.2%), and leukocytosis (50.0%). Hepatic disease (1 vs. 7, P = 0.009) was the only significant risk factor for underlying diseases. The mean value of lymphocyte (LYMPH#) (1.4 vs. 0.83 × 109/L, P = 0.033) counts was higher in the survival group than death group, while both anemia (8 vs. 10, P = 0.024) and hypoproteinemia (8 vs. 10, P = 0.024) occurred more frequently in the death group compared with the survival one. Conclusion Fever was the most common symptom and the only significant factor of underlying diseases was hepatic disease (P = 0.009) that often occurred in death groups. In this investigation, the risk factors for death in patients were anemia, hypoproteinemia, and lymphocyte count. The susceptibility of some quinolones, piperacillin-tazobactam, and cotrimoxazole was relatively high, suggesting that they may be the preferred drugs for the treatment of E. meningoseptica infection. As E. meningoseptica can produce biofilm to pollute the hospital environment and cause infection in patients, the disinfection of the hospital environment should be strengthened and medical staff should pay attention to aseptic operations.
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11
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Antimicrobial activities of sitafloxacin and comparators against the clinical isolates of less common nonfermenting Gram-negative bacteria. J Glob Antimicrob Resist 2022; 30:123-126. [PMID: 35697209 DOI: 10.1016/j.jgar.2022.06.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Revised: 06/01/2022] [Accepted: 06/03/2022] [Indexed: 11/22/2022] Open
Abstract
The in vitro antimicrobial activities of sitafloxacin and comparators against 320 clinical isolates of less common nonfermenting Gram-negative bacteria (NFGNB) were assessed by determining the minimum inhibitory concentrations (MICs) using broth microdilution method. In terms of MIC50/90 values, sitafloxacin was highly active against Stenotrophomonas maltophilia (0.25/1 mg/L), Burkholderia cepacia complex (0.25/2 mg/L), Achromobacter xylosoxidans (0.25/1 mg/L), and Chryseobacterium gleum (1/2 mg/L), but less active for Elizabethkingia (1/8 mg/L) and Chryseobacterium indologenes (16/32 mg/L). Sitafloxacin was more active than other fluoroquinolones against these NFGNB except Chryseobacterium. The results are helpful for clinicians to be aware of the role of sitafloxacin in managing the infections caused by these NFGNB.
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12
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Murthy NS, Shivappa SG, Tejashree A, Karthik KMVS, Deepashree R. Neonatal Meningitis with Septicemia by Elizabethkingia meningoseptica: A Case Report. J Lab Physicians 2022; 14:362-364. [PMID: 36119432 PMCID: PMC9473925 DOI: 10.1055/s-0042-1742635] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
Abstract
Abstract
Elizabethkingia is ubiquitary aerobic bacillus abundantly found in the community as well as hospital environments. Elizabethkingia meningoseptica is an emerging nosocomial pathogen with an elemental ability to acclimate and survive in diversified environmental circumstances. Prompt diagnosis and an early therapeutic intervention are preponderant in the management of these infections. We report a case of meningitis with septicemia caused by E. meningoseptica in a 1-day-old outborn neonate. The child was stabilized with anticonvulsants and, based on laboratory findings, the neonate was started on ciprofloxacin in addition to symptomatic management. The child responded well to the treatment and was discharged on day 7 after treatment initiation. Perceptive treatment protocols backed with accurate laboratory evidence remain instrumental to avert unpropitious outcomes while combatting rare multidrug-resistant opportunistic infections.
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Affiliation(s)
- Neetha S. Murthy
- Department of Microbiology, JSS Medical College, Mysuru, Karnataka, India
| | - Sowmya G. Shivappa
- Department of Microbiology, JSS Medical College, Mysuru, Karnataka, India
| | - A. Tejashree
- Department of Microbiology, JSS Medical College, Mysuru, Karnataka, India
| | | | - R. Deepashree
- Department of Microbiology, JSS Medical College, Mysuru, Karnataka, India
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13
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Waleed MS, Amba V, Varughese AA, Pathalapati R. Elizabethkingia meningoseptica Bacteremia and Meningitis: A Case Report. Cureus 2021; 13:e19275. [PMID: 34881128 PMCID: PMC8644112 DOI: 10.7759/cureus.19275] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/05/2021] [Indexed: 11/22/2022] Open
Abstract
Elizabethkingia meningoseptica (Chryseobacterium meningosepticum) is a gram-negative aerobic organism with yellow pigments. Although extremely rare, human infections associated with this organism have been reported. Elizabethkingia meningoseptica is usually resistant to most antibiotics. Herein, we present a case of a 70-year-old woman suffering from Elizabethkingia meningoseptica bacteremia and meningitis. Early diagnosis and treatment are vital for an improved patient outcome. Physicians and microbiologists should be equipped with adequate knowledge regarding this infection and its treatment.
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Affiliation(s)
| | - Vineeth Amba
- Medicine, Rutgers Robert Wood Johnson Medical School, New Brunswick, USA
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14
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Lee DH, Patel RH, Mehra I, Shenoy R, Nanjappa S, Greene J. A Case Series of Elizabethkingia meningosepticum Bacteremia in the Cancer Population. Cureus 2021; 13:e18627. [PMID: 34786228 PMCID: PMC8580113 DOI: 10.7759/cureus.18627] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2021] [Accepted: 10/09/2021] [Indexed: 11/11/2022] Open
Abstract
Elizabethkingia meningosepticum (E.meningosepticum) is a ubiquitous microorganism previously known as Chryseobacterium meningosepticum. It is emerging as a pathogen responsible for bacteremia in the immunocompromised population, particularly in cancer patients and those with a history of prolonged hospital stay and frequent instrumentations. A retrospective chart review of all cases over 10 years at the Moffitt Cancer Center showed a total of three patients with E.meningosepticum infection. The first patient (history of multiple myeloma) underwent endoscopy complicated by aspiration pneumonia and positive blood culture for E.meningosepticum infection. The second patient (current acute myelogenous leukemia) had neutropenic fever in the setting of a recent chest port infection. Blood culture from the chest port showed E. meningosepticum. The third patient (history of esophageal adenocarcinoma and acute myelogenous leukemia) had a history of recent pneumonia and cellulitis who presented with recurrent neutropenic fever. Blood culture was positive for E. meningosepticum. E.meningosepticum bacteremia has a high 28-day mortality rate (41%). As these three cases illustrate, early identification of the pathogen along with empiric treatment with a fluoroquinolone and/or minocycline is indicated to reduce morbidity and mortality.
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Affiliation(s)
- Dae Hyun Lee
- Cardiology, University of South Florida, Tampa, USA
| | - Raj H Patel
- Internal Medicine, Edward Via College of Osteopathic Medicine, Monroe, USA
| | - Ishita Mehra
- Internal Medicine, North Alabama Medical Center, Florence, USA
| | - Rahul Shenoy
- Internal Medicine, Case Western Reserve University, Cleveland, USA
| | | | - John Greene
- Internal Medicine, Moffitt Cancer Center, Tampa, USA
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15
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Yang C, Liu Z, Yu S, Ye K, Li X, Shen D. Comparison of three species of Elizabethkingia genus by whole-genome sequence analysis. FEMS Microbiol Lett 2021; 368:6164865. [PMID: 33693941 DOI: 10.1093/femsle/fnab018] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Accepted: 03/04/2021] [Indexed: 12/11/2022] Open
Abstract
Elizabethkingia are found to cause severe neonatal meningitis, nosocomial pneumonia, endocarditis and bacteremia. However, there are few studies on Elizabethkingia genus by comparative genomic analysis. In this study, three species of Elizabethkingia were found: E. meningoseptica, E. anophelis and E. miricola. Resistance genes and associated proteins of seven classes of antibiotics including beta-lactams, aminoglycosides, macrolides, tetracyclines, quinolones, sulfonamides and glycopeptides, as well as multidrug resistance efflux pumps were identified from 20 clinical isolates of Elizabethkingia by whole-genome sequence. Genotype and phenotype displayed a good consistency in beta-lactams, aminoglycosides and glycopeptides, while contradictions exhibited in tetracyclines, quinolones and sulfonamides. Virulence factors and associated genes such as hsp60 (htpB), exopolysaccharide (EPS) (galE/pgi), Mg2+ transport (mgtB/mgtE) and catalase (katA/katG) existed in all clinical and reference strains. The functional analysis of the clusters of orthologous groups indicated that 'metabolism' occupied the largest part in core genome, 'information storage and processing' was the largest group in both accessory genome and unique genome. Abundant mobile elements were identified in E. meningoseptica and E. anophelis. The most significant finding in our study was that a single clone of E. anophelis had been circulating within diversities of departments in a clinical setting for nearly 18 months.
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Affiliation(s)
- Chen Yang
- Center of Laboratory Medicine, the First Medical Center of Chinese PLA General Hospital, 28 Fu Xing Road, Beijing 100853, China
| | - Zhe Liu
- Center of Laboratory Medicine, the First Medical Center of Chinese PLA General Hospital, 28 Fu Xing Road, Beijing 100853, China
| | - Shuai Yu
- Department of Tropical Medicine and Infectious Diseases, Hainan Hospital, PLA General Hospital, 80 Jiang Lin Road, Sanya, Hainan Province 572016, China
| | - Kun Ye
- Center of Laboratory Medicine, the First Medical Center of Chinese PLA General Hospital, 28 Fu Xing Road, Beijing 100853, China
| | - Xin Li
- Center of Laboratory Medicine, the First Medical Center of Chinese PLA General Hospital, 28 Fu Xing Road, Beijing 100853, China
| | - Dingxia Shen
- Center of Laboratory Medicine, the First Medical Center of Chinese PLA General Hospital, 28 Fu Xing Road, Beijing 100853, China
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16
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Qin H, Zhang J, Qiao K, Zhang D, He W, Liu C, Fang Z, Guo K. Palladium-Catalyzed C2-Regioselective Perfluoroalkylation of the Free (NH)-Heteroarenes. J Org Chem 2021; 86:2840-2853. [PMID: 33433213 DOI: 10.1021/acs.joc.0c02782] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
A highly regioselective and atom-efficient strategy for the construction of fused free (NH) heteroarenes through a palladium-catalyzed perfluoroalkyl insertion reaction has been accomplished. This protocol employed multiple iodofluoroalkanes as practical and available perfluoroalkyl sources to provide an operationally simple and versatile route for the synthesis of perfluoroalkylated indoles. Moreover, indoles without the assistance of guide groups were utilized as substrates, achieving C(sp2)-H site-selective functionalization of indoles in yields up to 95%. Furthermore, this protocol was also used for late-stage C2 perfluoroalkylation of bioactive compounds such as auxin, tryptophan, and melatonin analogues.
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Affiliation(s)
- Hong Qin
- College of Biotechnology and Pharmaceutical Engineering, Nanjing Tech University, 30 Puzhu Road South, Nanjing 211816, P. R. China
| | - Jie Zhang
- College of Biotechnology and Pharmaceutical Engineering, Nanjing Tech University, 30 Puzhu Road South, Nanjing 211816, P. R. China
| | - Kai Qiao
- College of Biotechnology and Pharmaceutical Engineering, Nanjing Tech University, 30 Puzhu Road South, Nanjing 211816, P. R. China
| | - Dong Zhang
- College of Biotechnology and Pharmaceutical Engineering, Nanjing Tech University, 30 Puzhu Road South, Nanjing 211816, P. R. China
| | - Wei He
- College of Biotechnology and Pharmaceutical Engineering, Nanjing Tech University, 30 Puzhu Road South, Nanjing 211816, P. R. China
| | - Chengkou Liu
- College of Biotechnology and Pharmaceutical Engineering, Nanjing Tech University, 30 Puzhu Road South, Nanjing 211816, P. R. China
| | - Zheng Fang
- College of Biotechnology and Pharmaceutical Engineering, Nanjing Tech University, 30 Puzhu Road South, Nanjing 211816, P. R. China
| | - Kai Guo
- College of Biotechnology and Pharmaceutical Engineering, Nanjing Tech University, 30 Puzhu Road South, Nanjing 211816, P. R. China.,State Key Laboratory of Materials-Oriented Chemical Engineering, Nanjing Tech University, Nanjing 210009, P. R. China
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17
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Baruah FK, Borkakoty B, Ahmed A, Bora P. Neonatal Meningitis and Septicemia Caused by Multidrug-Resistant Elizabethkingia anophelis Identified by 16s Ribosomal RNA: An Emerging Threat. J Glob Infect Dis 2020; 12:225-227. [PMID: 33888964 PMCID: PMC8045540 DOI: 10.4103/jgid.jgid_126_19] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2019] [Revised: 07/15/2020] [Accepted: 07/22/2020] [Indexed: 11/25/2022] Open
Abstract
Elizabethkingia anophelis infections are emerging, especially among premature newborns, immunocompromised, and critically ill patients. The importance of correctly identifying this Gram-negative organism lies in the fact that it is associated with fatal complications such as meningitis, acute pulmonary edema, congestive cardiac failure, septic shock, and death. In addition, it is inherently resistant to multiple antibiotics which are used to treat Gram-negative bacilli. Here, we report a case of E. anophelis related meningitis and septicemia in a preterm neonate along with a brief review of literature.
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Affiliation(s)
- Frincy K Baruah
- Department of Microbiology, Excelcare Hospitals, Guwahati, Assam, India
| | | | - Abid Ahmed
- Department of Paediatrics, Excelcare Hospitals, Guwahati, Assam, India
| | - Prakritish Bora
- Department of Paediatrics, Excelcare Hospitals, Guwahati, Assam, India
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18
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Burnard D, Gore L, Henderson A, Ranasinghe A, Bergh H, Cottrell K, Sarovich DS, Price EP, Paterson DL, Harris PNA. Comparative Genomics and Antimicrobial Resistance Profiling of Elizabethkingia Isolates Reveal Nosocomial Transmission and In Vitro Susceptibility to Fluoroquinolones, Tetracyclines, and Trimethoprim-Sulfamethoxazole. J Clin Microbiol 2020; 58:e00730-20. [PMID: 32580952 PMCID: PMC7448627 DOI: 10.1128/jcm.00730-20] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Accepted: 06/12/2020] [Indexed: 12/14/2022] Open
Abstract
The Elizabethkingia genus has gained global attention in recent years as containing sporadic, worldwide, nosocomial pathogens. Elizabethkingia spp. are intrinsically multidrug resistant, primarily infect immunocompromised individuals, and are associated with high mortality (∼20 to 40%). As yet, gaps remain in our understanding of transmission, global strain relatedness, antimicrobial resistance, and effective therapy. Over a 16-year period, 22 clinical and 6 hospital environmental isolates were collected from Queensland, Australia. Identification using matrix-assisted laser desorption ionization-time of flight mass spectrometry (MALDI-TOF MS) (Vitek MS) and whole-genome sequencing was compared with a global strain data set. Phylogenomic reconstruction robustly identified 22 Elizabethkingia anophelis, 3 Elizabethkingia miricola, 2 Elizabethkingia meningoseptica, and 1 Elizabethkingia bruuniana isolates, most of which branched as unique lineages. Global analysis revealed that some Australian E. anophelis isolates are genetically closely related to strains from the United States, England, and Asia. Comparative genomics of clinical and environmental strains identified evidence of nosocomial transmission in patients, indicating probable infection from a hospital reservoir. Furthermore, broth microdilution against 39 antimicrobials revealed almost ubiquitous resistance to aminoglycosides, carbapenems, cephalosporins, and penicillins. Like other international strains, our isolates expressed susceptibility to minocycline and levofloxacin and the less common trimethoprim-sulfamethoxazole. Our study demonstrates important new insights into the genetic diversity, environmental persistence, and transmission of and potential effective therapy for Australian Elizabethkingia species.
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Affiliation(s)
- Delaney Burnard
- University of Queensland Centre for Clinical Research, Royal Brisbane and Woman's Hospital, Herston, Queensland, Australia
- Genecology Research Centre, University of the Sunshine Coast, Sippy Downs, Queensland, Australia
- Sunshine Coast Health Institute, Birtinya, Queensland, Australia
| | - Letitia Gore
- Central Microbiology, Pathology Queensland, Queensland Health, Herston, Queensland, Australia
| | - Andrew Henderson
- University of Queensland Centre for Clinical Research, Royal Brisbane and Woman's Hospital, Herston, Queensland, Australia
| | - Ama Ranasinghe
- University of Queensland Centre for Clinical Research, Royal Brisbane and Woman's Hospital, Herston, Queensland, Australia
| | - Haakon Bergh
- Central Microbiology, Pathology Queensland, Queensland Health, Herston, Queensland, Australia
| | - Kyra Cottrell
- University of Queensland Centre for Clinical Research, Royal Brisbane and Woman's Hospital, Herston, Queensland, Australia
| | - Derek S Sarovich
- Genecology Research Centre, University of the Sunshine Coast, Sippy Downs, Queensland, Australia
- Sunshine Coast Health Institute, Birtinya, Queensland, Australia
| | - Erin P Price
- Genecology Research Centre, University of the Sunshine Coast, Sippy Downs, Queensland, Australia
- Sunshine Coast Health Institute, Birtinya, Queensland, Australia
| | - David L Paterson
- University of Queensland Centre for Clinical Research, Royal Brisbane and Woman's Hospital, Herston, Queensland, Australia
| | - Patrick N A Harris
- University of Queensland Centre for Clinical Research, Royal Brisbane and Woman's Hospital, Herston, Queensland, Australia
- Central Microbiology, Pathology Queensland, Queensland Health, Herston, Queensland, Australia
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19
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Wang L, Zhang X, Li D, Hu F, Wang M, Guo Q, Yang F. Molecular Characteristics and Antimicrobial Susceptibility Profiles of Elizabethkingia Clinical Isolates in Shanghai, China. Infect Drug Resist 2020; 13:247-256. [PMID: 32099417 PMCID: PMC6996224 DOI: 10.2147/idr.s240963] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2019] [Accepted: 01/20/2020] [Indexed: 12/15/2022] Open
Abstract
Purpose To investigate molecular characteristics and antimicrobial susceptibility profiles of clinical isolates of Elizabethkingia in Shanghai, China. Methods Elizabethkingia isolates were collected in a university-affiliated hospital in 2012–2015 and 2017–2018. They were re-identified to species level by 16S rRNA gene and species-specific gene sequencing. Antimicrobial susceptibility testing, screening for metallo-beta-lactamase production, identification of antimicrobial resistance genes and pulsed-field gel electrophoresis (PFGE) were performed. Results Among 52 Elizabethkingia isolates, E. anophelis was the most prevalent species (67.3%), followed by E. meningoseptica (26.9%). High carriage rates of blaCME, blaBlaB and blaGOB genes were consistent with the poor in vitro activity of most β-lactams including carbapenems. Nevertheless, β-lactamase inhibitors increased susceptibility rates significantly for cefoperazone and piperacillin. Susceptibility rates for minocycline, tigecycline, rifampin and levofloxacin were 100%, 78.8%, 76.9% and 71.2%, respectively. Ser83Ile or Ser83Arg substitution in the DNA gyrase A unit was associated with resistance to fluoroquinolones. MIC50/MIC90 values of vancomycin and linezolid were 16/16 mg/L and 16/32 mg/L, respectively. Molecular typing showed twenty-one different types of PFGE and more than one indistinguishable isolates were observed in each of the eight subtypes. Conclusion Tetracyclines, tigecycline, β-lactam/β-lactamase inhibitor combinations, rifampin and fluoroquinolones demonstrated high rates of in vitro activity against clinical isolates of Elizabethkingia. Both genetic diversity and clonality were observed from this health-care facility. Our report provides potential alternative treatment options for Elizabethkingia infections.
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Affiliation(s)
- Leilei Wang
- Institute of Antibiotics, Huashan Hospital, Fudan University, Shanghai, People's Republic of China.,Key Laboratory of Clinical Pharmacology of Antibiotics, Ministry of Health, Shanghai, People's Republic of China
| | - Xuefei Zhang
- Institute of Antibiotics, Huashan Hospital, Fudan University, Shanghai, People's Republic of China.,Key Laboratory of Clinical Pharmacology of Antibiotics, Ministry of Health, Shanghai, People's Republic of China
| | - Dan Li
- Institute of Antibiotics, Huashan Hospital, Fudan University, Shanghai, People's Republic of China.,Key Laboratory of Clinical Pharmacology of Antibiotics, Ministry of Health, Shanghai, People's Republic of China
| | - Fupin Hu
- Institute of Antibiotics, Huashan Hospital, Fudan University, Shanghai, People's Republic of China.,Key Laboratory of Clinical Pharmacology of Antibiotics, Ministry of Health, Shanghai, People's Republic of China
| | - Minggui Wang
- Institute of Antibiotics, Huashan Hospital, Fudan University, Shanghai, People's Republic of China.,Key Laboratory of Clinical Pharmacology of Antibiotics, Ministry of Health, Shanghai, People's Republic of China
| | - Qinglan Guo
- Institute of Antibiotics, Huashan Hospital, Fudan University, Shanghai, People's Republic of China.,Key Laboratory of Clinical Pharmacology of Antibiotics, Ministry of Health, Shanghai, People's Republic of China
| | - Fan Yang
- Institute of Antibiotics, Huashan Hospital, Fudan University, Shanghai, People's Republic of China.,Key Laboratory of Clinical Pharmacology of Antibiotics, Ministry of Health, Shanghai, People's Republic of China
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20
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Lin JN, Lai CH, Yang CH, Huang YH. Elizabethkingia Infections in Humans: From Genomics to Clinics. Microorganisms 2019; 7:microorganisms7090295. [PMID: 31466280 PMCID: PMC6780780 DOI: 10.3390/microorganisms7090295] [Citation(s) in RCA: 79] [Impact Index Per Article: 15.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2019] [Revised: 08/21/2019] [Accepted: 08/27/2019] [Indexed: 12/21/2022] Open
Abstract
The genus Elizabethkingia has recently emerged as a cause of life-threatening infections in humans, particularly in immunocompromised patients. Several new species in the genus Elizabethkingia have been proposed in the last decade. Numerous studies have indicated that Elizabethkingia anophelis, rather than Elizabethkingia meningoseptica, is the most prevalent pathogen in this genus. Matrix-assisted laser desorption/ionization–time of flight mass spectrometry systems with an extended spectrum database could reliably identify E. anophelis and E. meningoseptica, but they are unable to distinguish the remaining species. Precise species identification relies on molecular techniques, such as housekeeping gene sequencing and whole-genome sequencing. These microorganisms are usually susceptible to minocycline but resistant to most β-lactams, β-lactam/β-lactam inhibitors, carbapenems, and aminoglycosides. They often exhibit variable susceptibility to piperacillin, piperacillin-tazobactam, fluoroquinolones, and trimethoprim-sulfamethoxazole. Accordingly, treatment should be guided by antimicrobial susceptibility testing. Target gene mutations are markedly associated with fluoroquinolone resistance. Knowledge on the genomic characteristics provides valuable insights into in these emerging pathogens.
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Affiliation(s)
- Jiun-Nong Lin
- School of Medicine, College of Medicine, I-Shou University, Kaohsiung 824, Taiwan.
- Division of Infectious Diseases, Department of Internal Medicine, E-Da Hospital, I-Shou University, Kaohsiung 824, Taiwan.
- Department of Critical Care Medicine, E-Da Hospital, I-Shou University, Kaohsiung 824, Taiwan.
| | - Chung-Hsu Lai
- School of Medicine, College of Medicine, I-Shou University, Kaohsiung 824, Taiwan
- Division of Infectious Diseases, Department of Internal Medicine, E-Da Hospital, I-Shou University, Kaohsiung 824, Taiwan
| | - Chih-Hui Yang
- Department of Biological Science and Technology, Meiho University, Pingtung 912, Taiwan
| | - Yi-Han Huang
- School of Medicine, College of Medicine, I-Shou University, Kaohsiung 824, Taiwan
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21
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Chan JC, Chong CY, Thoon KC, Tee NWS, Maiwald M, Lam JCM, Bhattacharya R, Chandran S, Yung CF, Tan NWH. Invasive paediatric Elizabethkingia meningoseptica infections are best treated with a combination of piperacillin/tazobactam and trimethoprim/sulfamethoxazole or fluoroquinolone. J Med Microbiol 2019; 68:1167-1172. [PMID: 31199227 PMCID: PMC7423161 DOI: 10.1099/jmm.0.001021] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Objectives Elizabethkingia meningoseptica is a multi-drug-resistant organism that is associated with high mortality and morbidity in newborn and immunocompromised patients. This study aimed to identify the best antimicrobial therapy for treating this infection. Methods A retrospective descriptive study was conducted from 2010 to 2017 in a tertiary paediatric hospital in Singapore. Paediatric patients aged 0 to 18 years old with a positive culture for E. meningoseptica from any sterile site were identified from the hospital laboratory database. The data collected included clinical characteristics, antimicrobial susceptibility and treatment, and clinical outcomes. Results Thirteen cases were identified in this study. Combination therapy with piperacillin/tazobactam and trimethoprim/sulfamethoxazole or a fluoroquinolone resulted in a cure rate of 81.8 %. The mortality rate was 15.4 % and neurological morbidity in patients with bacteraemia and meningitis remained high (75 %). Conclusions Treatment with combination therapy of piperacillin/tazobactam and trimethoprim/sulfamethoxazole or a fluroquinolone was effective in this study, with low mortality rates being observed.
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Affiliation(s)
- J C Chan
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore.,Department of Paediatrics, KK Women's and Children's Hospital, Singapore
| | - C Y Chong
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore.,Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore.,Duke-National University of Singapore Medical School, Singapore.,Department of Paediatrics, Infectious Disease Service, KK Women's and Children's Hospital, Singapore
| | - K C Thoon
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore.,Department of Paediatrics, Infectious Disease Service, KK Women's and Children's Hospital, Singapore.,Duke-National University of Singapore Medical School, Singapore
| | - N W S Tee
- Duke-National University of Singapore Medical School, Singapore.,Department of Pathology and Laboratory Medicine, National University Hospital, Singapore.,Department of Microbiology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - M Maiwald
- Department of Microbiology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore.,Department of Pathology and Laboratory Medicine, KK Women's and Children's Hospital, Singapore
| | - J C M Lam
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore.,Duke-National University of Singapore Medical School, Singapore.,Department of Paediatric Subspecialties, Haematology/Oncology Service, KK Women's and Children's Hospital, Singapore
| | - R Bhattacharya
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore.,Duke-National University of Singapore Medical School, Singapore.,Department of Paediatric Subspecialties, Haematology/Oncology Service, KK Women's and Children's Hospital, Singapore
| | - S Chandran
- Duke-National University of Singapore Medical School, Singapore.,Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore.,Yong Loo Lin School of Medicine, National University of Singapore, Singapore.,Department of Neonatology, KK Women's and Children's Hospital, Singapore
| | - C F Yung
- Department of Paediatrics, Infectious Disease Service, KK Women's and Children's Hospital, Singapore.,Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
| | - N W H Tan
- Duke-National University of Singapore Medical School, Singapore.,Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore.,Yong Loo Lin School of Medicine, National University of Singapore, Singapore.,Department of Paediatrics, Infectious Disease Service, KK Women's and Children's Hospital, Singapore
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22
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Comparison of Clinical Manifestations, Antimicrobial Susceptibility Patterns, and Mutations of Fluoroquinolone Target Genes between Elizabethkingia meningoseptica and Elizabethkingia anophelis Isolated in Taiwan. J Clin Med 2018; 7:jcm7120538. [PMID: 30545016 PMCID: PMC6306790 DOI: 10.3390/jcm7120538] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2018] [Revised: 12/08/2018] [Accepted: 12/10/2018] [Indexed: 01/30/2023] Open
Abstract
Elizabethkingia meningoseptica and Elizabethkingia anophelis are two major pathogens in the genus Elizabethkingia. Studies have revealed that Elizabethkingia anophelis is frequently misidentified as E. meningoseptica. Therefore, our aim was to explore the clinical and molecular differences between these two species. The database of a clinical microbiology laboratory in a university-affiliated hospital of Taiwan was searched to identify patients with Elizabethkingia infections between January 2005 and June 2018. Species were reidentified using 16S ribosomal RNA gene sequencing. Twenty E. meningoseptica and 72 E. anophelis samples were collected from consecutive patients. E. meningoseptica was significantly more frequently isolated from the cerebrospinal fluid than was E. anophelis. The most susceptible antibiotic for all Elizabethkingia isolates was minocycline (91.3%), followed by levofloxacin (52.2%), tigecycline (23.9%), and piperacillin tazobactam (23.9%). Compared with E. anophelis, E. meningoseptica was significantly less susceptible to piperacillin tazobactam, minocycline, and levofloxacin. Regarding nonsynonymous substitutions in the quinolone-resistance determining regions of DNA gyrase, six sites were recognized in E. meningoseptica and one site was recognized in E. anophelis. E. meningoseptica had a significantly higher rate of fluoroquinolone target gene mutations than did E. anophelis. Because of less susceptibility to multiple antibiotics than E. anophelis, empirical antimicrobial therapy of E. meningoseptica should be more rigorous.
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Chen WC, Chen YW, Ko HK, Yu WK, Yang KY. Comparisons of clinical features and outcomes between Elizabethkingia meningoseptica and other glucose non-fermenting Gram-negative bacilli bacteremia in adult ICU patients. JOURNAL OF MICROBIOLOGY, IMMUNOLOGY, AND INFECTION = WEI MIAN YU GAN RAN ZA ZHI 2018; 53:344-350. [PMID: 30274894 DOI: 10.1016/j.jmii.2018.08.016] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/11/2018] [Revised: 08/23/2018] [Accepted: 08/24/2018] [Indexed: 12/29/2022]
Abstract
BACKGROUND Clinical information of Elizabethkingia meningoseptica (EM) bacteremia in intensive care unit (ICU) patients is limited and the impact on outcomes uncertain. The aim of this study was to investigate the clinical features and impact of EM bacteremia compared to other glucose non-fermenting Gram-negative bacilli (GNF-GNB) bacteremia in ICU patients. METHODS This retrospective cohort study enrolled 70 patients who developed GNF-GNB bacteremia after ICU admission, including 19 cases of EM bacteremia (19/70, 27.1%). The main outcome measure was in-hospital mortality. RESULTS The patients with EM bacteremia had a lower rate of appropriate antibiotic therapy (15.8% vs. 62.7%, p < 0.001) and a longer time to appropriate antibiotic therapy (76.8 ± 46.4 vs. 35.1 ± 38.7 h, p < 0.001), but with a less severity in acute physiology and chronic health evaluation (APACHE) II score and shock status (p < 0.05) at the onset of bacteremia, compared to those with non-EM bacteremia. The in-hospital mortality between those with EM bacteremia and non-EM bacteremia was similar (63.2% vs. 51.0%, p = 0.363). However, primary bacteremia was more frequently noted in EM compared with non-EM group (57.9% vs. 25.5%, p = 0.011), and odds ratio 4.294 (95% confidence interval 1.292-14.277, p = 0.017) in multivariate regression analysis. CONCLUSION Among the patients with GNF-GNB bacteremia, the numbers of the cases with primary bacteremia and inappropriate therapy were significantly more in EM group than those in non-EM group.
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Affiliation(s)
- Wei-Chih Chen
- Department of Chest Medicine, Taipei Veterans General Hospital, Taipei, Taiwan; Faculty of Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan; Institute of Emergency and Critical Care Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Yen-Wen Chen
- Department of Chest Medicine, Taipei Veterans General Hospital, Taipei, Taiwan; Faculty of Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Hsin-Kuo Ko
- Department of Chest Medicine, Taipei Veterans General Hospital, Taipei, Taiwan; Faculty of Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Wen-Kuang Yu
- Department of Chest Medicine, Taipei Veterans General Hospital, Taipei, Taiwan; Faculty of Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Kuang-Yao Yang
- Department of Chest Medicine, Taipei Veterans General Hospital, Taipei, Taiwan; Faculty of Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan; Institute of Emergency and Critical Care Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan.
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Jian MJ, Cheng YH, Perng CL, Shang HS. Molecular typing and profiling of topoisomerase mutations causing resistance to ciprofloxacin and levofloxacin in Elizabethkingia species. PeerJ 2018; 6:e5608. [PMID: 30225179 PMCID: PMC6139017 DOI: 10.7717/peerj.5608] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2018] [Accepted: 08/19/2018] [Indexed: 12/02/2022] Open
Abstract
Objectives Several Elizabethkingia species often exhibit extensive antibiotic resistance, causing infections associated with severe morbidity and high mortality rates worldwide. In this study, we determined fluoroquinolone susceptibility profiles of clinical Elizabethkingia spp. isolates and investigated the resistance mechanisms. Methods In 2017–2018, 131 Elizabethkingia spp. isolates were recovered from specimens collected at tertiary care centers in northern Taiwan. Initial species identification using the Vitek MS system and subsequent verification by 16S rRNA sequencing confirmed the presence of Elizabethkingia anophelis (n = 111), E. miricola (n = 11), and E. meningoseptica (n = 9). Fluoroquinolone susceptibility was determined using the microbroth dilution method, and fluoroquinolone resistance genes were analyzed by sequencing. Results Among Elizabethkingia spp. isolates, 91% and 77% were resistant to ciprofloxacin and levofloxacin, respectively. The most prevalent alterations were two single mutations in GyrA, Ser83Ile, and Ser83Arg, detected in 76% of the isolates exhibiting fluoroquinolone MIC between 8 and 128 μg/ml. Another GyrA single mutation, Asp87Asn, was identified in two quinolone-resistant E. miricola strains. None of the isolates had alterations in GyrB, ParC, or ParE. We developed a high-resolution melting assay for rapid identification of the prevalent gyrA gene mutations. The genetic relationship between the isolates was evaluated by random amplified polymorphic DNA PCR that yielded diverse pulsotypes, indicating the absence of any temporal or spatial overlap among the patients during hospitalization. Conclusion Our analysis of fluoroquinolone-resistant Elizabethkingia spp. isolates provides information for further research on the variations of the resistance mechanism and potential clinical guidance for infection management.
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Affiliation(s)
- Ming-Jr Jian
- Graduate Institute of Medical Science, National Defense Medical Center, Taipei, Taiwan.,Division of Clinical Pathology, Department of Pathology, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Yun-Hsiang Cheng
- Graduate Institute of Medical Science, National Defense Medical Center, Taipei, Taiwan.,Division of Clinical Pathology, Department of Pathology, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Cherng-Lih Perng
- Graduate Institute of Medical Science, National Defense Medical Center, Taipei, Taiwan.,Division of Clinical Pathology, Department of Pathology, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Hung-Sheng Shang
- Graduate Institute of Medical Science, National Defense Medical Center, Taipei, Taiwan.,Division of Clinical Pathology, Department of Pathology, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
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Huang YC, Wu PF, Lin YT, Wang FD. Comparison of clinical characteristics of bacteremia from Elizabethkingia meningoseptica and other carbapenem-resistant, non-fermenting Gram-negative bacilli at a tertiary medical center. JOURNAL OF MICROBIOLOGY, IMMUNOLOGY, AND INFECTION = WEI MIAN YU GAN RAN ZA ZHI 2018; 52:304-311. [PMID: 30097388 DOI: 10.1016/j.jmii.2018.06.007] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/02/2017] [Revised: 06/19/2018] [Accepted: 06/21/2018] [Indexed: 01/15/2023]
Abstract
BACKGROUND Acquired carbapenem resistance among non-fermenting Gram-negative bacilli (NFGNB), such as Pseudomonas aeruginosa and Acinetobacter calcoaceticus-Acinetobacter baumannii complex (ACB complex), is a serious problem in nosocomial infections. We previously reported that patients infected with the intrinsically carbapenem-resistant Elizabethkingia meningoseptica were associated with high mortality. However, little information is available regarding the clinical outcome of E. meningoseptica bacteremia when compared to that of other carbapenem-resistant NFGNB. METHODS We conducted an observational study that included consecutive patients with E. meningoseptica, carbapenem-resistant ACB complex, carbapenem-resistant P. aeruginosa, and Stenotrophomonas maltophilia bacteremia at a Taiwanese medical center in 2015. We compared the clinical characteristics and outcomes between patients with E. meningoseptica bacteremia and those with other carbapenem-resistant NFGNB bacteremia. RESULTS We identified 30 patients with E. meningoseptica, 71 with carbapenem-resistant ACB complex, 25 with S. maltophilia, and 17 with carbapenem-resistant P. aeruginosa bacteremia. The clinical characteristics, disease severity, and previous antibiotic exposures were similar between patients with bacteremia either due to E. meningoseptica or other carbapenem-resistant NFGNB. Patients with E. meningoseptica bacteremia had a higher rate of appropriate empirical antibiotics than those with other carbapenem-resistant NFGNB and was less associated with central venous catheterization. The 28-day mortality rates were similar between patients with E. meningoseptica and the other carbapenem-resistant NFGNB bacteremia (46.7% vs 46%, p = 0.949). CONCLUSION The mortality rate of E. meningoseptica bacteremia was as high as other carbapenem-resistant NFGNB infections. The emerging E. meningoseptica infection calls for active surveillance and continued awareness from clinical physicians for this serious carbapenem-resistant infection.
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Affiliation(s)
- Ying-Chi Huang
- Division of Infectious Diseases, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Ping-Feng Wu
- Division of Infectious Diseases, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan; School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Yi-Tsung Lin
- Division of Infectious Diseases, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan; Institute of Emergency and Critical Care Medicine, National Yang-Ming University, Taipei, Taiwan.
| | - Fu-Der Wang
- Division of Infectious Diseases, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan; School of Medicine, National Yang-Ming University, Taipei, Taiwan
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Emerging Infection with Elizabethkingia Meningoseptica in Neonate. A Case Report. ACTA ACUST UNITED AC 2018; 4:96-100. [PMID: 30582002 PMCID: PMC6294984 DOI: 10.2478/jccm-2018-0013] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2018] [Accepted: 05/04/2018] [Indexed: 12/19/2022]
Abstract
Background Elizabethkingia meningoseptica are Gram-negative rod bacteria which are commonly found in the environment. The bacteria have also been associated with nosocomial infections, having been isolated on contaminated medical equipment, especially in neonatal wards. Case report Here, we present the case of a premature female infant born at 33 weeks’ gestational age, with neonatal meningitis. The onset was marked by fever, in the 5th day of life, while in the Neonatal Intensive Care Unit. The patient was commenced on Gentamicin and Ampicillin, but her clinical condition worsened. Psychomotor agitation and food refusal developed in the 10th day of life, and a diagnosis of bacterial meningitis was made based on clinical and cerebrospinal fluid findings. A strain of Elizabethkingia meningoseptica sensitive to Vancomycin, Rifampicin and Clarithromycin was isolated from cerebrospinal fluid. First-line antibiotic therapy with Meropenem and Vancomycin was adjusted by replacing Meronem with Piperacillin/Tazobactam and Rifampicin. The patient’s clinical condition improved, although some isolated febrile episodes were still present. The cerebrospinal fluid was normalized after 6 weeks of antibiotic treatment, although periventriculitis and tetraventricular hydrocephalus were revealed by imaging studies. Neurosurgical drainage was necessary. Conclusion Elizabethkingia meningoseptica can cause severe infection, with high risk of mortality and neurological sequelae in neonates. Intensive care and multidisciplinary interventions are crucial for case management.
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