Abstract
Elizabethkingia species (spp.), which can colonize hospital environments, are emerging nosocomial pathogens presenting high mortality. Due to their intrinsic resistance to a broad range of antibiotics, optimal antibiotic dosage has yet to be determined against infections caused by Elizabethkingia spp. This study aimed to investigate the risk factors for the mortality of infections caused by Elizabethkingia spp. and assess the clinical implications of their antimicrobial susceptibility patterns. Data from 210 patients affected by Elizabethkingia-induced pneumonia and bacteremia between 1 November 2005 and 31 May 2016, were analyzed. Further antimicrobial susceptibility tests for moxifloxacin, rifampin, and vancomycin using Elizabethkingia isolates were performed to compensate for the Elizabethkingia spp. susceptibility panel in patients affected after 2013. The mean age of the patients was 66.5 ± 18 years and the 28-day mortality rate was 25.2% (53/210). In the univariate analysis, history of prior stay in an intensive care unit, central venous catheter use, presented thrombocytopenia, immunocompetent status, a high simplified acute physiology score II (SAPS II score), a high C-reactive protein (CRP)/albumin ratio on the day of isolation and seven days later, and a high minimum inhibitory concentration (MIC) value of rifampin were significantly associated with a higher mortality rate. In the multivariate logistic regression analysis, the MIC values of rifampin (odds ratio (OR): 1.045; 95% confidence interval (CI): 1.006–1.085; p = 0.023), SAPS II score (OR: 1.053; 95% CI: 1.022–1.084; p = 0.001), and initial CRP/albumin ratio (OR: 1.030; 95% CI: 1.009–1.051; p = 0.004) were significantly associated with 28-day mortality. To reduce the mortality associated with Elizabethkingia infections, prediction of the clinical course using initial CRP/albumin ratio and SAPS II and early intervention are essential. Rifampin is a promising candidate as the drug of choice in treating Elizabethkingia infections.
Highlights
Elizabethkingia species are non-fermentative, non-motile, oxidase-positive, and non-glucosefermenting Gram-negative aerobic bacilli [1,2]
43 patients aged under 18 years, 217 patients showing colonization with Elizabethkingia spp., and 22 patients presenting with other infections were excluded
We conducted this study to identify the risk factors for the mortality associated with Elizabethkingia infections and to find the clinical impacts of the antimicrobial susceptibility patterns of Elizabethkingia spp., which are emerging nosocomial pathogens
Summary
Elizabethkingia species (spp.) are non-fermentative, non-motile, oxidase-positive, and non-glucosefermenting Gram-negative aerobic bacilli [1,2] They are ubiquitous saprophytes found in freshwater, saltwater, and soil environments [3]. Elizabethkingia spp. does not constitute human microflora [6]; it may colonize patients via fluid contaminated medical devices It can spread by wet and dry materials and surfaces, including the hands of hospital staff [10]
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