Elizabethkingia meningoseptica : An emerging pathogen causing meningitis in a hospitalized adult trauma patient.

A 23-year-old male patient who was a follow-up case of neurosurgery presented to our emergency department with a history of high-grade fever and clinical features of meningitis for 1 week. The cerebrospinal fluid (CSF) was sent to our laboratory for culture. The culture demonstrated growth of 1-2 mm in diameter light yellow coloured colonies of Gram-negative bacilli on chocolate and blood agar. There was no growth on MacConkey agar. The bacterium was multidrug resistant. Based upon the growth characteristics, bio-chemical reactions, drug susceptibility pattern and identification by Vitek 2 system the isolate was identified as Elizabethkingia meningoseptica. Patient was treated with injection piperacillin-tazobactam, injection vancomycin and cotrimoxazole tablets for 21 days along with intrathecal injection of tigecycline and finally, patient improved clinically and the CSF cultures became sterile. The presence in hospital environment along with multidrug resistance makes E. meningoseptica a successful emerging nosocomial pathogen.

Vancomycin-resistant Enterococcus faecium isolated from pediatric patients / 대한임상병리학회지

BACKGROUND: Vancomycin resistance in enterococci is an emerging problem in Korea. It has become a worldwide problem and nosocomial spread of vancomycin-resistant enterococci (VRE) is very difficult to control. METHODS: Twenty-six strains of vancomycin-resistant Enterococcus faecium, which were isolated from clinical specimens at Soonchunhyang Chunan Hospital from September 1997 to July 1998, were evaluated to determine the antimicrobial susceptibility pattern, the vancomycin resistance genotypes, and their clinical characteristics. RESULTS: All strains were resistant to multiple antibiotics and resistant to vancomycin with MICs in excess of 256 g/ml. All isolates proved to have the vanA gene by the polymerase chain reaction. However, most of them were considered to be colonizations rather than infections from the clinical point of view. They were all cultured from patients who were being hospitalized or had been hospitalized in a neonatal intensive care unit or pediatric wards. Fourteen of 24 patients whose cultures were positive for VRE had a previous use of broad spectrum -lactam and/or vancomycin. CONCLUSIONS: Our cases indicate the importance of nosocomial spread of VRE via person-to-person transmission in a limited space. In order to prevent and control infection and colonization with VRE, a comprehensive and strategic plan such as the recommendations of the CDC's Hospital Infection Control Practices Advisory Committee, may be necessary.

Why do antimicrobial agents become ineffectual?

Antibiotic resistance has evolved over the past 50 years from a merely microbiological curiosity to a serious medical problem in hospitals all over the world. Resistance has been reported in almost all species of gram-positive and -negative bacteria to various classes of antibiotics including recently developed ones. Bacteria acquire resistance by reducing permeability and intracellular accumulation, by alteration of targets of antibiotic action, and by enzymatic modification of antibiotics. Inappropriate use of an antibiotic selects resistant strains much more frequently. Once resistant bacteria has emerged, the resistance can be transferred to other bacteria by various mechanisms, resulting in multiresistant strains. MRSA is one of the typical multiresistant nosocomial pathogens. A study of the PFGE pattern of endonuclease-digested chromosomal DNA showed that MRSA of a few clones were disseminated among newborns in the NICU of a Japanese hospital. In this regard, it is important to choose appropriate antibiotics and then after some time, to change to other classes to reduce the selection of resistant strains. Since the development of epoch-making new antibiotics is not expected in the near future, it has become very important to use existing antibiotics prudently based on mechanisms of antibiotic action and bacterial resistance. Control of nosocomial infection is also very important to reduce further spread of resistant bacteria.