Abstract
Unlike Elizabethkingia meningoseptica, the clinical importance of E. anophelis is poorly understood. We determined the clinical and molecular epidemiology of bacteremia caused by Elizabethkingia-like species from five regional hospitals in Hong Kong. Among 45 episodes of Elizabethkingia-like bacteremia, 21 were caused by Elizabethkingia, including 17 E. anophelis, three E. meningoseptica and one E. miricola; while 24 were caused by other diverse genera/species, as determined by 16S rRNA gene sequencing. Of the 17 cases of E. anophelis bacteremia, 15 (88%) were clinically significant. The most common diagnosis was pneumonia (n = 5), followed by catheter-related bacteremia (n = 4), neonatal meningitis (n = 3), nosocomial bacteremia (n = 2) and neutropenic fever (n = 1). E. anophelis bacteremia was commonly associated with complications and carried 23.5% mortality. In contrast, of the 24 episodes of bacteremia due to non-Elizabethkingia species, 16 (67%) were clinically insignificant. Compared to non-Elizabethkingia bacteremia, Elizabethkingia bacteremia was associated with more clinically significant infections (P < 0.01) and positive cultures from other sites (P < 0.01), less polymicrobial bacteremia (P < 0.01), and higher complication (P < 0.05) and mortality (P < 0.05) rates. Elizabethkingia bacteremia is predominantly caused by E. anophelis instead of E. meningoseptica. Elizabethkingia bacteremia, especially due to E. anophelis, carries significant morbidity and mortality, and should be considered clinically significant unless proven otherwise.
Highlights
Accurate diagnosis is important to guide appropriate antibiotic regimens which often consist of a combination of ciprofloxacin or rifampicin with piperacillin-tazobactam or vancomycin
Twenty-one of the 45 episodes of Elizabethkingia-like bacteremia were caused by Elizabethkingia, while 24 episodes were caused by diverse genera/species including Chryseobacterium (n = 15), Flavobacterium (n = 1), Planobacterium (n = 6), Sphingobacterium (n = 1) and Weeksella-like species (n = 1) according to 16S rRNA gene analysis (Fig. 1 and see Supplementary Table 1)
In contrast to the traditional belief that E. meningoseptica was the most important Elizabethkingia species associated with bacteremia, the present study showed that the majority of Elizabethkingia bacteremia cases were caused by E. anophelis
Summary
Accurate diagnosis is important to guide appropriate antibiotic regimens which often consist of a combination of ciprofloxacin or rifampicin with piperacillin-tazobactam or vancomycin. It was reported to cause neonatal meningitis in the Central African Republic and a nosocomial outbreak in an intensive-care unit in Singapore[10,11]. Our recent report on E. anophelis meningitis in two neonates and chorioamnionitis in a neonate’s mother in Hong Kong suggested that mosquitoes were unlikely the vehicles of transmission[12]. To better understand the epidemiology and clinical disease spectrum of E. anophelis and Elizabethkingia as a whole, we determined the clinical and molecular epidemiology of bacteremia caused by Elizabethkingia-like species from five regional hospitals in Hong Kong. All bacteremia episodes caused by Elizabethkingia-like species identified by conventional phenotypic tests from 2004 to 2013 during the study period were included. For the 45 episodes of Elizabethkingia-like bacteremia identified, 16S rRNA gene sequencing was performed for species identification and clinical characteristics and outcomes were analyzed
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