Keratitis with Elizabethkingia meningoseptica occurring after contact lens wear: a case report

Probability of outbreaks and cross-border dissemination of the emerging pathogen: a genomic survey of Elizabethkingia meningoseptica

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.

Post-Keratoplasty Infectious Keratitis Caused by Elizabethkingia meningoseptica

BACKGROUND Microbial keratitis is a major complication of keratoplasty that is associated with serious ocular sequalae if not adequately treated. The purpose of this case report is to present a case of infectious keratitis following keratoplasty caused by the rare microorganism Elizabethkingia meningoseptica. CASE REPORT A 73-year-old patient presented to the outpatient clinic complaining of a sudden decrease of vision in his left eye. The right eye was enucleated during childhood due to ocular trauma and an ocular prosthesis was placed in the orbital socket. He underwent penetrating keratoplasty 30 years ago for corneal scar and repeated optical penetrating keratoplasty for failed graft in 2016. He was diagnosed with microbial keratitis following optical penetrating keratoplasty in the left eye. Corneal scraping of the infiltrate showed growth of the gram-negative bacteria Elizabethkingia meningoseptica. Conjunctival swab of the orbital socket of the fellow eye was positive for the same microorganism. E. meningoseptica is a rare gram-negative bacterium, which is not part of the normal ocular flora. The patient was admitted for close monitoring and was started on antibiotics. He showed significant improvement after treatment with topical moxifloxacin and topical steroids. CONCLUSIONS Microbial keratitis is a serious complication following penetrating keratoplasty. An infected orbital socket could be a risk factor of microbial keratitis of the fellow eye. A high index of suspicion, along with timely diagnosis and management, may improve the outcome and clinical response and reduce the morbidity associated with these infections. Prevention of infectious keratitis is essential and may be achieved by optimizing the ocular surface and treating the risk factors for infection.

Prevalence of Elizabethkingia meningoseptica Infections and their Resistant Pattern in Tertiary Care Hospital

Elizabethkingia meningoseptica a rare pathogen in earlier times has been accused to infect the immunocompromised, preterm neonates, the patients exposed to longterm antibiotics and intensive care units. The apparent resistance of the multidrug Elizabethkingia meningoseptica affects the selection of appropriate antibacterial agents against it. The current study attempts to determine the prevalence of E. meningoseptica infections and consider the sensitivity pattern in a tertiary care hospital. A prospective study of prevalence of E. meningoseptica in a tertiary care hospital from March 2020 to March 2021 i.e over a period of 1 year. Patient clinical data as well as ABST patterns were collected and analyzed. Out of total 1813 patient’s samples E. meningoseptica was isolates from 21 cases (1.15%). Average age was 61.42 years, with males most likely to be infected (52.38%). All the adult patients had underlying diseases, obstructive gall bladder diseases (n=7, 33.33%) which included choledocholithiasis, obstructive jaundice, cholangitis and carcinoma gallbladder. Urinary tract diseases (n=8, 38.09%) which include chronic kidney disease (CKD) and acute kidney disease (AKD), pneumonia (n=11, 52.38%) including urosepsis and other diseases AML (n=1, 04.7%). Susceptibility tests showed 100% in vitro against few antimicrobials like cefepime, meropenem and amikacin which can be utilized to treat most common Gram-negative bacterial infections. Isolates are usually the completely sensitive to minocycline. E. meningoseptica is a rising microbe in intensive care setup due to its resistance pattern.

Clinical profile, susceptibility patterns, speciation and follow up of infections by Elizabethkingia species: study on a rare nosocomial pathogen from an intensive care unit of north India

Elizabethkingia sp. is an opportunistic nosocomially acquired Gram-negative bacterium usually implicated in isolated cases of meningitis, pneumonia, bacteraemia and sepsis. It is a sturdy pathogen, resistant to most of the first-line antibiotics routinely used in laboratories for other Gram-negative pathogens. The current study was planned to assess the demographic profile, clinical picture, sensitivity patterns and species identification of various Elizabethkingia isolates, as well as to follow up cases of infection. All clinical samples of blood, cerebrospinal fluid and respiratory specimens positive for Elizabethkingia during a 2-year period were included in the study. The isolates were first identified with a Vitek-2 GN card system and further confirmed by matrix-assisted laser desorption/ionization time-of-flight mass spectrometry. Follow-up visits of the patients with their demographic records, morbidities and treatment outcomes were also planned and studied. Over a period of 2 years, samples from 27 individuals showed positive growth of Elizabethkingia spp. Among these 27 individuals, 19 were adults and 8 were neonates. Blood samples yielded most isolates (52.6%; n = 10); followed by tracheal aspirate, bronchoalveolar lavage fluid, and cerebrospinal fluid. Eleven out of 27 patients (40.7%) showed concomitant growth of other pathogens along with Elizabethkingia spp.; predominantly Gram-negative organisms. Both species of Elizabethkingia showed 100% susceptibility to drugs such as minocycline and piperacillin-tazobactam. A favourable outcome was seen in 76.9% of the individuals with timely institution of antibiotics and proper diagnosis. Bloodstream infections and meningitis were identified as the most common clinical conditions associated with mortality. Infections due to Elizabethkingia are on the rise in developing countries like India. As a result there is an urgent need to study this pathogen in greater detail to understand its pathogenesis, clinical implications and treatment outcomes, especially in hospital settings such as intensive care units.

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Elizabethkingia species is an opportunistic nosocomially acquired Gram negative bacteria usually implicated in isolated cases of meningitis, pneumonia, bacteremia, and sepsis.

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It is a sturdy pathogen resistant to most of the first line antibiotics routinely used in the laboratories for other Gram negative pathogens.

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It is implicated in a wide range of infections in both neonates and adults.

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Literature search reveals very scarce studies and case reports on this rare opportunistic pathogen in the healthcare settings and there is a dire need to study this pathogen in greater detail in a developing country like India.

Draft Genome Sequence of Elizabethkingia meningoseptica, Isolated from a Postoperative Endophthalmitis Patient

We present the draft genome assembly of an Elizabethkingia meningoseptica strain isolated from a 67-year-old postoperative endophthalmitis patient who suffered loss of vision in the right eye. The draft genome assembly has 167 contigs with a total size of 4,019,665 bp encoding multiple drug-resistant genes.

Elizabethkingia meningoseptica: an important emerging pathogen causing healthcare-associated infections

Elizabethkingia meningoseptica has been deemed a potentially important threat to patients in critical care areas because of its multidrug-resistant phenotype and its ability to adapt to various environments. This review considers the incidence, factors which predispose to, and clinical features of, E. meningoseptica sepsis, along with antimicrobial susceptibility patterns of clinical E. meningoseptica isolates and reportedly successful measures for the prevention and control of infections caused by this bacterium. The English-language literature from the PubMed database was reviewed. The incidence of E. meningoseptica bacteraemia has increased over the last decade. Patients at high risk of E. meningoseptica infection include preterm children, the immunocompromised and those exposed to antibiotics in critical care units. Vancomycin, rifampicin, newer fluoroquinolones, piperacillin-tazobactam, minocycline and possibly tigecycline are preferred empirical choices for E. meningoseptica infection according to in-vitro susceptibility data. Combination therapy has been used for infections not responding to single agents. Saline, lipid, and chlorhexidine gluconate solutions as well as contaminated sinks have been implicated as sources of infection following outbreak investigations. In addition to reinforcement of standard infection control measures, actions that have successfully terminated E. meningoseptica outbreaks include pre-emptive contact isolation, systematic investigations to identify the source of the bacterium and thorough cleaning of equipment and environmental surfaces. As the clinical complexity and incidence of E. meningoseptica infections increase, there is a need for heightened awareness of the potential for this bacterium to cause outbreaks. This will permit timely initiation of active surveillance for infected/colonized patients as well as investigations to identify the likely source of the bacterium, which will, in turn, allow implementation of appropriate infection control measures.

Draft Genome Sequences of Elizabethkingia meningoseptica

Elizabethkingia meningoseptica is ubiquitous in nature, exhibits a multiple-antibiotic resistance phenotype, and causes rare opportunistic infections. We now report two draft genome sequences of E. meningoseptica type strains that were sequenced independently in two laboratories.