Neumonía bullosa secundaria a Elizabethkingia meningoseptica, su evolución clínica y radiológica / Bullous pneumonia secondary to Elizabethkingia meningoseptica, its clinical and radiological evolution

Elizabethkingia meningoseptica es un patógeno oportunista, con una elevada mortalidad y una incidencia en aumento en las terapias intensivas. Se presenta a una paciente de 4 años con antecedente de atresia de vías biliares y trasplante hepático a los 11 meses de vida, que se internó por infección respiratoria aguda baja con hipoxemia. Durante la internación, sufrió un empeoramiento clínico con requerimiento de asistencia respiratoria mecánica. Por fiebre e hipoxemia persistente, se realizó un minilavado broncoalveolar, con cultivo positivo para Elizabethkingia meningoseptica. Recibió vancomicina, trimetoprima/sulfametoxazol y ciprofloxacina durante 14 días, con buena respuesta. Una tomografía de tórax evidenció la presencia de hipoperfusión en mosaico, imágenes quísticas y bronquiectasias bilaterales. Durante los siguientes 2 años, presentó una buena evolución clínica, con escasas intercurrencias respiratorias, síntomas intercrisis aislados y buena tolerancia al ejercicio. En las imágenes de control, se evidenció la resolución de la mayoría de las lesiones iniciales a los 20 meses de su seguimiento.

Elizabethkingia meningoseptica is an opportunistic pathogen with a high mortality and an increasing incidence in the intensive care units. We present a 4-year-old patient with a history of atresia of the biliary tract and a liver transplant at 11 months of age, who was admitted for acute respiratory infection with hypoxemia. During the hospitalization, she required mechanical ventilation. Due to persistent fever and hypoxemia, mini bronchoalveolar lavage was performed with a positive culture for Elizabethkingia meningoseptica. She received vancomycin, trimethoprim/sulfamethoxazole and ciprofloxacin for 14 days with a good response. A chest tomography showed the presence of mosaic hypoperfusion, cystic images, and bilateral bronchiectasis. During the following 2 years, she presented good clinical progress, with scarce respiratory infections, isolated symptoms and good tolerance to exercise. The resolution of the majority of the initial lesions was evidenced at 20 months of follow-up.

Experience with Elizabethkingia meningoseptica Infection in Adult Patients at a Tertiary Hospital / 대한중환자의학회지

BACKGROUND: Few reports have documented the clinical characteristics and treatment outcomes of adult patients with Elizabethkingia meningoseptica infection. METHODS: Medical records of patients over 18 years of age and suspected of having an E. meningoseptica infection from March 1, 2006 to February 28, 2013 were reviewed retrospectively. Their clinical characteristics, antimicrobial susceptibility results, and treatment outcomes were analyzed. RESULTS: E. meningoseptica was isolated from 30 patients. Median age was 68.5 years, and infections were more frequent in males (17, 56.7%). The most common isolation source was sputum (23, 76.7%), and pneumonia was the most common condition (21, 70%) after excluding two cases of colonization. This bacterium was most susceptible to minocycline (27, 90%) and fluoroquinolones, including levofloxacin (20, 66.7%) and ciprofloxacin (18, 60%). The mortality rate due directly to E. meningoseptica infection was 20% (6/30), and uncontrolled pneumonia was the only cause of death. After isolating E. meningoseptica, the numbers of patients with pneumonia (9/9, 100% vs. 12/21, 57.1%), history of hemodialysis (5/9, 55.6% vs. 3/21, 14.3%), tracheostomy (8/9, 88.9 vs. 10/21, 47.6%), and median Charlson comorbidity index score (6 [range, 3-9] vs. 4 [range, 0-9]) were significantly higher in non-survivors than those in survivors (p < 0.05, for each). However, only 12 (40%) patients received appropriate antibiotics. CONCLUSIONS: E. meningoseptica infection most commonly presented as pneumonia in adults with severe underlying diseases. Despite the high mortality rate, the rate of appropriate antibiotic use was notably low.

Experience with Elizabethkingia meningoseptica Infection in Adult Patients at a Tertiary Hospital / 대한구급학회지

BACKGROUND: Few reports have documented the clinical characteristics and treatment outcomes of adult patients with Elizabethkingia meningoseptica infection. METHODS: Medical records of patients over 18 years of age and suspected of having an E. meningoseptica infection from March 1, 2006 to February 28, 2013 were reviewed retrospectively. Their clinical characteristics, antimicrobial susceptibility results, and treatment outcomes were analyzed. RESULTS: E. meningoseptica was isolated from 30 patients. Median age was 68.5 years, and infections were more frequent in males (17, 56.7%). The most common isolation source was sputum (23, 76.7%), and pneumonia was the most common condition (21, 70%) after excluding two cases of colonization. This bacterium was most susceptible to minocycline (27, 90%) and fluoroquinolones, including levofloxacin (20, 66.7%) and ciprofloxacin (18, 60%). The mortality rate due directly to E. meningoseptica infection was 20% (6/30), and uncontrolled pneumonia was the only cause of death. After isolating E. meningoseptica, the numbers of patients with pneumonia (9/9, 100% vs. 12/21, 57.1%), history of hemodialysis (5/9, 55.6% vs. 3/21, 14.3%), tracheostomy (8/9, 88.9 vs. 10/21, 47.6%), and median Charlson comorbidity index score (6 [range, 3-9] vs. 4 [range, 0-9]) were significantly higher in non-survivors than those in survivors (p < 0.05, for each). However, only 12 (40%) patients received appropriate antibiotics. CONCLUSIONS: E. meningoseptica infection most commonly presented as pneumonia in adults with severe underlying diseases. Despite the high mortality rate, the rate of appropriate antibiotic use was notably low.

A Case of Peritonitis caused by Chryseobacterium meningosepticum in a Patient Treated with Peritoneal Dialysis / 대한신장학회지

Chryseobacterium meningosepticum is rarely encountered as a pathogen causing peritonitis in peritoneal dialysis (PD) patients. We report a case of peritonitis due to Chryseobacterium meningosepticum, which was treated successfully with intraperitoneal (IP) vancomycin and ciprofloxacin, and without PD catheter removal. Peritonitis was developed in a 53-year-old PD patient on the third hospital day. Although empirical IP treatment with cefazolin and tobramycin was initiated and maintained for 3 days, the fever and signs of peritonitis persisted. Antibiotics were changed to cefoperazone/sulbactam, amikacin, and vancomycin due to clinical deterioration. After 3 days of vancomycin use, leukocyte count in PD fluid was less than 100/mm3 and the patient became asymptomatic. On seventh day after the onset of peritonitis, Chryseobacterium meningosepticum was isolated from initial dialysate sample, and this strain was susceptible to ciprofloxacin, piperacillin, and piperacillin/tazobactam. Accordingly, we changed the antibiotics to ciprofloxacin and vancomycin, which were given for the total of 14 days. Even though Chryseobacterium meningosepticum is an uncommon causative organism of peritonitis in PD patients, this report suggests that vancomycin and ciprofloxacin are effective as empiric therapy, and early suspicion and appropriate antimicrobial therapy are crucial to the successful treatment of peritonitis due to Chryseobacterium meningosepticum without catheter removal.

A case of community-acquired pneumonia and sepsis caused by Chryseobacterium meningosepticum / 대한내과학회지

Chryseobacterium meningosepticum is a ubiquitous Gram-negative rod widely distributed in natural and hospital environments. It mostly causes meningitis in premature and newborn infants. Few such cases have been reported in Korea, and no case of community-acquired pneumonia caused by Chryseobacterium meningosepticum. A 53-year-old man was brought to the emergency department because of severe pneumonia. We report a case of community-acquired pneumonia and sepsis caused by Chryseobacterium meningosepticum.

Two cases of Chryseobacterium meningosepticum infection in a neonatal intensive care unit / 소아과

We report on two premature infants who developed nosocomial infection caused by Chryseobacterium meningosepticum in a neonatal intensive care unit (NICU). One premature infant developed sepsis, meningitis, and hydrocephalus, and was treated successfully with ciprofloxacin plus trimethoprim-sulfamethoxazole combination therapy for 4 weeks and with a ventriculoperitoneal shunt. The other premature infant, who was in a chronically debilitated state, had infection that had colonized only in the respiratory tract but had no clinical signs for 66 days. Extensive environmental surveillance demonstrated that the suction bottle apparatus was the source of infection. We prevented the spread of infection by closing the NICU temporarily, isolating the patients early in their infection, and eradicating the source of infection source.

Nosocomial Lung Infection by Chryseobacterium meningosepticum:Risk Factors and Drug-resistance / 中华医院感染学杂志

OBJECTIVE To analyze the risk factors and the drug-resistance of nosocomial acquired lung infection by Chryseobacterium meningosepticum.METHODS A retrospective investigation of the clinical correlative data and the drug sensitivity results of 60 cases with nosocomial acquired lung infection by C.meningosepticum from Jan 2004 to Jan 2006 was conducted in local hospital.RESULTS The patients were mainly distributed at ICU,respiration and neurosurgery wards.They had severe underlying diseases(100.0%),tracheal intubation(56.7%),central venous catheter(25.0%) and urine catheter(16.7%) treatments and applications of more than three antibiotics(68.3%).The drug-resistance of C.meningosepticum was serious.The antibiotic drugs which had higher susceptibility ratio were cefoperazone/sulbactam,fluoroquinolones,et al.CONCLUSIONS The main risk factors of nosocomial acquired lung infection by C.meningosepticum are severe underlying diseases,various invasive treatments,long-term hospitalization and inappropriate use of broad spectrum antibiotics.Clinical isolates are multi-drug resistant to many kinds of antibiotics.

Drug Resistance of Chryseobacterium meningosepticum / 中华医院感染学杂志

OBJECTIVE To compare and analyze the drug resistance of Chryseobacterium meningosepticum which producing metallo-?-lactamase(MBL) and extended-spectrum-?-lactamases(ESBLs) from ICU patients′ and non ICU patients′ specimens of sputa so as to guide the rational application of antibiotics.METHODS Identified the strains with VITEK 32,MBL and ESBLs were also screened by double disk synergy;the antimicrobial sensitivity of clinical isolates was tested by VITEK GNS143 and the antimicrobial sensitivity was added and tested by K-B method.RESULTS As a result the rate of producing MBL of C.meningosepticum was 49.0% from ICU patients′ specimens of sputa which was higher than the rate of 13.8% from non ICU patients′;the rate of producing ESBLs of C.meningosepticum was 37.2% from ICU patients′ specimens of sputa which was higher than the rate of 30.6% from non ICU patients′;the rate of drug resistance to AMP/SUB,TZP,CEP,CIP,and LEV from ICU patients′ was higher than that from non ICU patients.CONCLUSIONS Why the high resistance rate of C.mengingosepticum in ICU patients′ specimens of sputa might be due to the high producing ?-lactamases(MBL and ESBLs).

Antimicrobial Sensitivity of Chryseobacterium meningosepticum:Analysis of 36 Clinical Isolates / 中华医院感染学杂志

OBJECTIVE To approach to the point of clinical diagnosis and treatment in patients with Chryseobacterium meningosepticum(CM) infection,and test the high sensitivey antibiotic in order to provide evidence for clinical rational drug utilization.METHODS We had retrospectively analyzed the 36 clinical infections with CM during 2003.A microdilution broth method was used to detect the C.meningosepticum MIC and metallo-?-(lactamases-)production.RESULTS C.meningosepticum infections related to the critical underlying diseases,old age,stay in hospital,nosocomial infections and broad spectrum antibiotics use.Metallo-?-lactamases-producing accounted for 100% in all CM isolates.CM were susceptible or partly susceptible to VAN,CTX/CA,PIP/SU,CFP/SU,PIP,CIA,PIP which were 100%,100%,91.7%,88.9%,86.1%,72.2%,and 44.4%,respectively.The(susceptibility) to other 21 kinds of antimicrobials were in 8.3%.CONCLUSIONS CM is multi-drug resistant.The main risk factors of CM infection are old age,long-term in hospital,critical underlying disease,and decreased immunological function.VAN,CTX/CA,PIP/SU, CFP/SU,PIP,CIA,and PIP are the effective antibiotics(against) CM.