Elizabethkingia Meningoseptica Research Articles

Elizabethkingia meningoseptica Carbapenem Resistance in Cerebrospinal Fluid Cultures of Patients Suspected of Bacterial Meningitis: A Case Report

Background: Elizabethkingia meningoseptica is a Gram-negative bacterium that rarely causes meningitis in children. These infections are often resistant to carbapenem antibiotics, making diagnosis and treatment more complicated. Case presentation: A 1-month-old male patient was treated to the PICU of Dr. M. Djamil General Hospital Padang with symptoms of decreased consciousness, seizures, and fever. The patient was diagnosed with bacterial meningitis and was referred from Sungai Dareh Regional General Hospital with previous therapy for 4 days. A cerebrospinal fluid examination showed increased protein and decreased glucose, and a CT scan showed hydrocephalus. The cerebrospinal fluid culture showed growth of Elizabethkingia meningoseptica which was resistant to imipenem and meropenem. The patient was treated with a combination of non-carbapenem antibiotics and recovered from meningitis. Conclusion: Carbapenem-resistant Elizabethkingia meningoseptica is a rare causative agent of meningitis in children. Early diagnosis and treatment with appropriate non-carbapenem antibiotics are essential to increase the chance of cure.

Identification and characterization of emGalaseE, a β-1,4 galactosidase from Elizabethkingia meningoseptica, and its application on living cell surface

The biological function of terminal galactose on glycoprotein is an open field of research. Although progress had being made on enzymes that can remove the terminal galactose on glycoproteins, there is a lack of report on galactosidases that can work directly on living cells. In this study, a unique beta 1,4 galactosidase was isolated from Elizabethkingia meningoseptica (Em). It exhibited favorable stability at various temperatures (4–37 °C) and pH (5–8) levels and can remove β-1, 4 linked galactoses directly from glycoproteins. Using Alanine scanning, we found that two acidic residues (Glu-468, and Glu-531) in the predicted active pocket are critical for galactosidase activity. In addition, we also demonstrated that it could cleave galactose residues present on living cell surface. As this enzyme has a potential application for living cell glycan editing, we named it emGalaseE or glycan-editing galactosidase I (csgeGalaseI). In summary, our findings lay the groundwork for further investigation by presenting a simple and effective approach for the removal of galactose moieties from cell surface.

Insilico screening to identify novel inhibitors targeting 30S ribosomal protein S12 in meningitis-causing organism ‘Elizabethkingia meningoseptica’

The current trend in biomedical research is on prioritizing infections based on multidrug resistance. Elizabethkingia meningoseptica, a nosocomial infection-causing organism emerging from Neonatal Intensive Care Units (NICUs), leads to neonatal meningitis and sepsis resulting in severe illness, and, in some cases, fatal. Finding a solution remains challenging due to limited prior work. Translational S12 ribosomal proteins play a crucial role in decoding the codon-anticodon helix, which is essential for the survival of E. meningoseptica. These proteins do not exhibit significant similarity with humans, making them potential drug targets. An in silico study aims to identify specific inhibitors for E. meningoseptica ribosomal proteins among known bioactive compounds targeting prokaryotic 30S ribosomal protein. A 3D model of the 7JIL_h protein from Flavobacterium johnsoniae, showing 90% sequence similarity with the target protein was generated using SWISS-MODEL software. The model was validated through Molprobity v4.4, VERIFY 3D, Errata, and ProSA analysis, confirming conserved residues of the target protein. Insilico screening of known bioactive compounds and their analogs identified potential ligands for the target protein. Molecular Docking and post-docking analysis assessed the stability of the protein-ligand complexes among the shortlisted compounds. The top two compounds with high Gold fitness scores and low predicted binding energy underwent MD simulation and further estimation of free binding energy using the MM_PBSA module. These computationally shortlisted compounds, namely chEMBL 1323619 and chEMBL 312490 may be considered for future in-vivo studies as potential inhibitors against the modeled 30S ribosomal protein S12 of E. meningoseptica. Communicated by Ramaswamy H. Sarma

Two promising candidates for paratransgenesis, Elizabethkingia and Asaia, increase in both sexes of Anopheles gambiae mosquitoes after feeding

BackgroundThe male mosquito microbiome may be important for identifying ideal candidates for disease control. Among other criteria, mosquito-associated symbionts that have high localization in both male and female mosquitoes and are transmissible through both vertical and sexual routes are desirable. However, mosquito microbiome studies have mainly been female-focused. In this study, the microbiota of male and female Anopheles gambiae sensu lato (s.l.) were compared to identify shared or unique bacteria.MethodsLate larval instars of Anopheles mosquitoes were collected from the field and raised to adults. Equal numbers of males and females of 1-day-old non-sugar-fed, 4–5-day-old sugar-fed and post-blood-fed females were randomly selected for whole-body analyses of bacteria 16S rRNA.ResultsResults revealed that male and female mosquitoes generally share similar microbiota except when females were blood-fed. Compared to newly emerged unfed mosquitoes, feeding on sugar and/or blood increased variability in microbial composition (⍺-diversity), with a higher disparity among females (39% P = 0.01) than in males (29% P = 0.03). Elizabethkingia meningoseptica and Asaia siamensis were common discriminants between feeding statuses in both males and females. While E. meningoseptica was particularly associated with sugar-fed mosquitoes of both sexes and sustained after blood feeding in females, A. siamensis was also increased in sugar-fed mosquitoes but decreased significantly in blood-fed females (LDA score > 4.0, P < 0.05). Among males, A. siamensis did not differ significantly after sugar meals.ConclusionsResults indicate the opportunities for stable infection in mosquitoes should these species be used in bacteria-mediated disease control. Further studies are recommended to investigate possible host-specific tissue tropism of bacteria species which will inform selection of the most appropriate microbes for effective transmission-blocking strategies.

Draft genome sequence of novel Candidatus Ornithobacterium hominis carrying antimicrobial resistance genes in Egypt

BackgroundCandidatus Ornithobacterium hominis (O. hominis), which was identified in nasopharyngeal swabs from Egypt, has been associated with respiratory disorders in humans. O. hominis, a recently identified member of the Flavobacteriaceae family, belongs to the largest family within the Bacteroidetes phylum. This family includes hundreds of species and 90 genera, including major human pathogens such as Capnocytophaga canimorsus and Elizabethkingia meningoseptica. Herein, we presented two draft genome assemblies of O. hominis that were extracted from metagenomic data using the Illumina sequencing method. The alignment of reads against the O. hominis genome was accomplished using BLASTN, and the reads with significant hits were extracted using Seqtk and assembled using SPAdes. The primary goal of this study was to obtain a more profound understanding of the genomic landscape of O. hominis, with an emphasis on identifying the associated virulence, antimicrobial genes, and distinct defense mechanisms to shed light on the potential role of O. hominis in human respiratory infections.ResultsThe genome size was estimated to be 1.84 Mb, including 1,931,660 base pairs (bp), with 1,837 predicted coding regions and a G+C content of 35.62%. Genes encoding gliding motility, antibiotic resistance (20 genes), and the toxA gene were all included in the genome assembly. Gliding motility lipoproteins (GldD, GldJ, GldN, and GldH) and the gliding motility-associated ABC transporter substrate-binding protein, which acts as a crucial virulence mechanism in Flavobacterium species, were identified. The genome contained unique genes encoding proteins, such as the ParE1 toxin that defend against the actions of quinolone and other antibiotics. The cobalt-zinc-cadmium resistance gene encoding the protein CzcB, which is necessary for metal resistance, urease regulation, and colonization, was also detected. Several multidrug resistance genes encoding proteins were identified, such as MexB, MdtK, YheI, and VanC.ConclusionOur study focused on identifying virulence factors, and antimicrobial resistance genes present in the core genome of O. hominis. These findings provide valuable insights into the potential pathogenicity and antibiotic susceptibility of O. hominis.

Meningitis Caused by the Rare Bacterium Elizabethkingia meningoseptica, in Only One Twin, Late Preterm Newborn, with Complications-Case Report

Introduction: Elizabethkingia meningoseptica (EM) is a gram-negative aerobic organism that can cause severe infections. Although the incidence is higher in developing countries, human infections associated with this organism are seldom described in Serbia. This bacterium is usually resistant to most antibiotics, making the treatment challenging. We present a single twin born as a late-preterm newborn who developed sepsis and meningitis caused by EM. Case Presentation: This case report aims to show that this rare bacterium is present in our country and the clinical presentation of the resulting disease and bacterial resistance to antibiotics. In addition, we assessed if a more thorough diagnosis, including the immunological status of the newborn, is needed. Conclusions: Considering the high mortality and morbidity rates of EM and its multiresistance, early identification of the infection cause and determining the patient’s immunological status are vital for treatment and improved patient outcomes.

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

The emerging infectious agent Elizabethkingia meningoseptica is associated with life-threatening infections in immunocompromised individuals. However, there are limited data on its geographic distribution, phylogenetic evolution, pathogenesis, and transmission. In this study, we comprehensively analyze and compare the genomic features, evolutionary history, emergence date, and transmission networks of global E. meningoseptica. Geographical distribution reveals the presence of the emerging bacteria in Asia, Europe, and North America, three continents with similar latitudes. Phylogenetic analyses show no relationship between the strain's evolutionary history and its location, origin, or source, despite the presence of genetic diversity. Analysis of the emergence timeline suggests that America is the most likely source of E. meningoseptica with the common ancestor of this pathogen dating back 90 years. Putative transmission networks indicate that E. meningoseptica bacteria can spread within the same hospital and even across borders. Minor variations in resistance genotypes and virulence genes are observed, supporting existing evidence of inherent resistance and pathogenicity in E. meningoseptica. Additionally, minocycline and doxycycline demonstrate potent antimicrobial activity against this pathogen, making them promising candidates for treating E. meningoseptica infections. Our research highlights the potential for severe nosocomial outbreaks caused by E. meningoseptica with horizontal transmission occurring between countries worldwide. To prevent future outbreak infections, increased genomic surveillance of global E. meningoseptica populations is necessary. 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.

Elizabethkingia meningoseptica: Changing anti microbial resistance causing fatal community-acquired neonatal meningitis – An area of rising concern

Elizabethkingia meningoseptica is often reported as a hospital-acquired infection. We present an unusual fatal case of community-acquired meningitis probably secondary to contamination of the breast pump and feeding bottle used at home. Despite being a Gram-negative bacillus, it is extremely sensitive to antibiotics used to treat Gram-positive infections. There is a lack of protocolized effective treatment regimens and the organism demonstrates in vitro resistance to many antibiotics but a changing pattern of resistance as seen in our case is not reported till date. E. meningoseptica is an emerging potential source of neonatal infection and is an upcoming public health problem.

A-289 Emergence of Unusual Non-Fermentative Gram-Negative Bacilli Associated to COVID-19 Period at Brazilian Hospitals

Abstract Background Since the global pandemic of coronavirus disease (COVID-19), some studies have reported on the emergence of opportunistic nosocomial pathogens associated with co-infection on the outcome of COVID-19 patients. The aim of this study was to describe the increase of six unusual species of Non-fermentative Gram-negative bacilli (NF-GNB) clinical isolates recovered from inpatients in several Brazilian hospitals comparing pre-Covid-19 (January 2018 to December 2019) period vs Covid-19 (January 2020 to December 2021) period. Methods This study design was a retrospective, observational analysis based on microbiological data of emergent NF-GNB isolates, detected in several Brazilian tertiary hospitals. The bacterial identification was performed by Matrix-Assisted Laser Desorption/Ionization Time-of-Flight Mass Spectrometry (MALDI-TOF/MS) and the susceptibility of antibiotics was determined using disk diffusion method. Results During the 48 months period, a total of 1665 (2018; 349), (2019; 351), (2020; 485), (2021; 480) emergent NF-GNB isolated from blood (n = 744), respiratory tract (n = 239), skin and soft tissue (n = 264); urine (n = 119), catheter (n = 101), fluid and secretions (n = 113), Cerebrospinal fluid (n = 12) and others (n = 73) were analyzed. The frequency of NF-BGN according to species level identification was Stenotrophomonas maltophilia (1040; 62.5%), Burkholderia cepacea complex (457; 27.4%), Elizabethkingia meningoseptica (64; 3.8%), Elizabethkingia miricola (31; 1.8%), Ochrobactrum anthropi (69; 4.1%) and Ochrobactrum intermedium (4; 0.2%). The prevalence of these NF-BGN detected in pre-Covid-19 period (2018–2019) and Covid-19 period (2020–2021) were 42% and 58%, respectively. The incidence of Stenotrophomonas maltophilia, Burkholderia cepacea complex, Elizabethkingia spp. and Ochrobactrum spp. infection was (47.7% and 52.3%), (42.9% and 57.1%), (43.2% and 56.8%) and (50.7% and 49.3%) among female and man patients, respectively. For Stenotrophomonas maltophilia, Burkholderia cepacea complex and Ochrobactrum spp. the main age range was over 60 years (44.5%, 44.9% and 42.5%) while for Elizabethkingia spp. the main age range was 0–10 years of age with 42.5% of cases in the pre-COVID-19 period and over 60 years old with 43.9% in the COVID-19 period. Compared the two periods (2018–2019 vs 2020–2021) for Stenotrophomonas maltophilia the resistance rate to levofloxacin and sulfamethoxazole-trimethoprim was (3.9% vs 4.6%) and (4% vs 4.2%), respectively. Conclusion Our data point to a scenario wherein the presence of opportunistic pathogens may have been intensified by the covid-19 pandemic. Further studies should be carried out to clarify these findings.

Elizabethkingia meningoseptica Outbreak in NICU: An Observational Study on a Debilitating Neuroinfection in Neonates

Background: Elizabethkingia meningoseptica is an emerging nosocomial pathogen implicated in neonatal sepsis with high mortality and morbidities. However, there is very limited data regarding the characteristics as well as outcomes following this infection, particularly in developing countries. Methods: We conducted a retrospective observational study of all infants with culture-positive Elizabethkingia sepsis as part of an outbreak, to study their clinical and epidemiological characteristics, as well as their antimicrobial susceptibility patterns, using a structured proforma from the neonatal intensive care unit database. Analysis was done using descriptive statistics and predictors of mortality and hydrocephalus were also identified. Results: Of the 21 neonates enrolled, 9 (42.9%) were male, with a mean gestational age and birth weight of 31.7 ± 3.4 weeks and 1320 ± 364 g, respectively. The median (interquartile range) age of onset of illness was 7 (5–12) days. The overall mortality rate was 23.8%, and among survivors, 50% had neurologic complications requiring intervention. Vancomycin and ciprofloxacin were the most used antibiotics for treatment in our series, with a median duration of 26 (17–38) days. On univariate analysis, shock at presentation was significantly associated with increased mortality (P = 0.04) while, seizures (P = 0.04) and elevated cerebrospinal fluid protein levels (P = 0 .01) at onset of illness predicted progressive hydrocephalus in surviving neonates. Conclusion: E. meningoseptica sepsis is associated with high morbidity and mortality. Early diagnosis and prompt initiation of appropriate antibiotics are critical for improving survival and neurodevelopmental outcomes. Though isolation of the organism by environmental surveillance is always not possible, with proper infection control measures, the infection can be controlled.

A rare case of Elizabethkingia meningoseptica infection in a neonate

Background: Elizabethkingia infections were reportedly rare, but if it was found, it had been known to cause neonatal meningitis, bloodstream infections and respiratory infections. Elizabethkingia meningoseptica had a unique antibiotic susceptibility pattern, usually resistant to most antibiotics. Elizabethkingia infections were associated with a high mortality rate because of the lack of effective therapeutic regimens, antibiotic resistance and virulence. Case Presentation: Fourteen days old boy patient came with the chief complaint of seizure, which occurred twice. Before the seizure, the patient had a fever with the highest temperature was 39°C. The patient looked lethargic, tended to sleep more often, cried occasionally and was not as active as previously. Septic marker revealed an Immature to Total neutrophil (IT) ratio of 0.2 and C-Reactive Protein (CRP) 49.30 mg/dL. A blood smear examination showed toxic granules, vacuolization of the leucocyte and reactive thrombocytosis. Cerebrospinal fluid analysis revealed a cell number of 2520 cell/uL, polymorphonuclear (PMN) cell 80%, mononuclear (MN) cell 20%, Nonne and Pandy was positive, protein level at 300 mg/dL and cerebrospinal fluid glucose level below 20 mg/dL. The patient was initially diagnosed with sepsis and meningitis and was given ampicillin and gentamicin. Blood and cerebrospinal fluid culture isolated Elizabethkingia meningoseptica and significantly as the infection-causing agent. The antibiotic sensitivity of the blood culture was ciprofloxacin and levofloxacin. The antibiotic sensitivity of the cerebrospinal fluid culture was levofloxacin. During the treatment, there were several inappropriate results between clinical manifestation and laboratory results; the antibiotic was changed to levofloxacin according to the sensitivity of the blood and cerebrospinal fluid culture. Conclusion: Elizabethkingia meningoseptica was a rare case, and the nature of this bacteria was resistant to multiple antibiotics. Treatment should be considered carefully.

Characterization and Molecular Mechanism of Aminoglycoside-6-Adenyl Transferase Associated with Aminoglycoside Resistance from Elizabethkingia meningoseptica.

Elizabethkingia meningoseptica (EM) is a multi-drug-resistant bacterium of global concern for its role in nosocomial infection and is generally resistant to aminoglycoside antibiotics. In the whole genome of an EM strain (FMS-007), an aminoglycoside-6-adenyl transferase gene (ant(6)FMS-007) was predicted. This study aimed to characterize the biochemical function of ANT(6)FMS-007 and analyze the relationship between genotype and phenotype of ant(6) in clinical EM isolates, so as to provide evidence for clinical precision drug use. This study could establish a method for the verification of known or unknown functionally resistant genes. A total of 42 EM clinical isolates were collected from clinical departments during 2015-2023. The phenotype of aminoglycoside antibiotics was analyzed by broth microdilution (BMD) and Kirby-Bauer (K-B) methods. The whole-length ant(6) from EM clinical isolates was analyzed by polymerase chain reaction (PCR) and sequencing. The biochemical function of predictive ANT(6)FMS-007 from the FMS-007 whole genome was identified by 3D plate experiment and mass spectrometry analysis. Candidate active sites were predicted by multi-species sequence alignment and molecular docking, and other important sites were identified in the comparison of ant(6) genotypes and phenotypes of EM clinical isolates. Drug susceptibility test was used to verify the function of these sites. The predictive ANT(6)FMS-007 protein could inactivate STR by modifying STR with ATP to form STR-AMP. Four active sites (Asp-38, Asp-42, Lys-95, and Lys-213) of ANT(6)FMS-007 were identified. Thirty-one EM clinical isolates (74%) carried the ant(6) gene. Eight EM clinical isolates containing the ant(6) gene had MIC values (<=32μg/mL) lower by at least 16-fold than FMS-007 (512μg/mL) for STR, and N59H and K204Q were the common mutations in the ant(6) gene. This assay verified the biochemical function of the predictive gene ant(6)FMS-007 and could provide an alternative method to study resistant gene function in multi-drug-resistant bacteria. The inconsistency between genotype and phenotype of resistant genes indicated that the combination of resistance gene detection and functional analysis could better provide precision medicine for clinical use.

The Effect of Treated Sulfur Water on the Microbial Content of the Soil and the Extent of Resistance of These Bacteria to Antibiotics

The research began on March 7, 2021, as the regions of Ain Al-Wusta and Ain Jarura were chosen to take soil samples. The sulfuric water was treated using laboratory batch reactors. Locally manufactured glass tubes were used, with dimensions 17 * 17 * 55 in length, width and height, respectively, Subsequently, microbiological and chemical analyzes of the soil were performed. The results of the study showed success of the physical treatment process that was used to reduce the levels of sulfur in the water Depending on the source of water and the type of material used, the triple-magnetic treatment achieved the highest removal rate of 73% in Ain Al-Wusta soil, 40% in soil sample B1, and 27% in soil sample B2 of Ain Jarura. The results of bacterial culture showed that Gram-negative bacteria were dominant by 100% in soil samples from Ain Jarura region treated with untreated sulfuric water (WA1, WA2, WA3) (Table- 4), as well as for the same soil samples treated with sulfuric water treated with sand filter (GB1), charcoal filter (GB2) and magnetic field filter. (GB3) Soil samples treated with untreated sulfur water were dominated by Pseudomonas aeruginosa with a percentage of 66.7% and Acinetobacter lwoffii with a percentage of 33.3%.The results of the bacterial count of soil samples from the Ain Jarura region showed that there were significant differences between the bacterial number with sulfuric water treated with the three filters, As for soil samples from Ain Al-Wusta region, only soil samples added to sulfuric water treated with charcoal filter (WB2) gave significant differences with a significant decrease of number (84×102 CFU) for the species Aerococcus viridans. The results of the antibiotic sensitivity test showed that Elizabethkingia meningoseptica gave the highest rate of resistance to antibiotics about 66%. The results of the study showed that the resistance of bacterial isolates to antibiotics did not show significant differences between soil samples treated with treated and untreated sulfur water, except for the GB2 isolate.

Genotypic and phenotypic analysis of Elizabethkingia meningoseptica in bullfrog Rana catesbeiana isolated in Taiwan.

Elizabethkingia meningoseptica is a hazardous bacterium for agriculture production and human health. The present study identified E. meningoseptica from the bullfrog, human and reference strain BCRC 10677 by API 20NE, 50S ribosome protein L27 sequencing and pulse field gel electrophoresis to differentiate isolates of E. meningoseptica from aquatic animals and humans. All isolates from bullfrogs and humans were identified as E. meningoseptica by DNA sequencing with 98.8%-100% sequence identity. E. meningoseptica displayed significant genetic diversity when analysed using pulsed-field gel electrophoresis (PFGE). There were six distinct pulsotypes, including one pulsotype found in bullfrog isolates and five pulsotypes found in human isolates. However, E. meningoseptica from bullfrog exhibited one genotype only by PFGE. Overall, molecular epidemiological analysis of PFGE results indicated that the frog E. meningoseptica outbreaks in Taiwan were produced by genetically identical clones. The bullfrog isolates were not genetically related to other E. meningoseptica from human and reference isolates. This research provided the first comparisons of biochemical characteristics and genetic differences of E. meningoseptica from human and bullfrog isolates.

The Role of Automation for Early Diagnosis of Non-fermenter Superbugs in Critically Ill Septicemic Hospitalized Patients.

Introduction Non-fermenting Gram-negative bacilli (NFGNB) are emerging superbugs of bloodstream infections (BSI), causing increased mortality in hospitalized patients. NFGNB are challenging to identify using conventional identification techniques. Hence, automation is beneficial for accurate and fast diagnosis; it also facilitates rapid treatment and recovery of patients. This study aims to isolate/identify NFGNB from BSI and determine its antimicrobial susceptibility pattern. Material and methods This study was conducted in the Department of Microbiology, LLRMMC, Meerut, for a period of six months (June to November 2022). The samples were processed using automated blood culture (BD BACTEC) and an identification/sensitivity testing system (BD Phoenix). Results Out of 1340 blood cultures, 347 (25.7%) were flagged positive for microbial growth. A total of 103 (7.6%) NFGNB were isolated, showing their strong association with BSI. The NFGNB isolates were Pseudomonas species 23 (22.3%), Acinetobacter baumannii 19 (18.4%), Salmonella spp. 19 (18.4%), Sphingomonas paucimobilis 17 (16.5%), Aeromonas hydrophila 5 (4.8%), Rhizobium radiobacter sp. 4 (3.8%), Stenotrophomonas maltophila 3 (2.9%), Burkholderia cepacian 3 (2.9%), Proteus mirabilis 2 (1.9%), Achromobacter xylosoxidans 2 (1.9%), Elizabethkingia meningoseptica 2 (1.9%), Ochromobacter anthropic 2 (1.9%), Cuprivadus pauculus 1 (0.9%), and Ralstonia mannitolilytica 1 (0.9%). Conclusions Automation helps in the prompt reporting of NFGNB and their antibiogram pattern by microbiology laboratories, facilitating the early and accurate management of patients with BSI.

Identification and characterization of an α-1,3 mannosidase from Elizabethkingia meningoseptica and its potential attenuation impact on allergy associated with cross-reactive carbohydrate determinant

Core α-1,3 mannose is structurally near the core xylose and core fucose on core pentasaccharide from plant and insect glycoproteins. Mannosidase is a useful tool for characterization the role of core α-1,3 mannose in the composition of glycan related epitope, especially for those epitopes in which core xylose and core fucose are involved. Through functional genomic analysis, we identified a glycoprotein α-1,3 mannosidase and named it MA3. We used MA3 to treat allergen horseradish peroxidase (HRP) and phospholipase A2 (PLA2) separately. The results showed that after MA3 removed α-1,3 mannose on HRP, the reactivity of HRP with anti-core xylose polyclonal antibody almost disappeared. And the reactivity of MA3-treated PLA2 with anti-core fucose polyclonal antibody decreased partially. In addition, when PLA2 was conducted enzyme digestion by MA3, the reactivity between PLA2 and allergic patients’ sera diminished. These results demonstrated that α-1,3 mannose was an critical component of glycan related epitope.

Elizabethkingia meningosepticum infections with varied presentations and different antimicrobial susceptibility - A case series.

We report three sporadic infections by Elizabethkingia meningosepticum from Government Medical College Kozhikode in Kerala state, South India over a period of three years. Two cases were commenced in the community in immunocompromised children beyond the newborn period, but both recovered promptly. Another was a hospital-acquired meningitis in a newborn baby who developed neurologic sequelae. In contrast to widespread antimicrobial resistance exhibited by this pathogen, there was good susceptibility to commonly used antimicrobials such as ampicillin, cefotaxime, piperacillin, ciprofloxacin, and vancomycin. Whilst ß lactam antibiotics are found effective in the treatment of Elizabethkingia septicaemia of children, piperacillin-tazobactam, vancomycin combination seems effective empiric choice of antibiotics for neonatal meningitis due to Elizabethkingia; there is a need for guidelines for the management of this infection, especially in neonatal meningitis.

Device-associated Meningitis due to Elizabethkingia meningoseptica: A Therapeutic Challenge.

To the Editors: Elizabethkingia meningoseptica causes life-threatening infections in humans, especially in immunocompromised patients and infants with low birth weights. It is one of the main causes of meningitis in pediatric and immunocompromised patients in the context of nosocomial diseases associated with devices and is also related to low-birth-weight infants and prematurity1 Due to their resistance to many commonly used antibiotics (beta-lactams, carbapenemics, aminoglycosides, etc.), clinicians face treatment challenges.2 There are currently few publications on pediatric cases regarding E. meningoseptica device-associated meningitis with breakthrough resistance to trimethoprim-sulfamethoxazole (TMP/SMX) while treatment with dual intravenous (IV) therapy with TMP/SMX and high-dose ciprofloxacin requiring intraventricular ciprofloxacin for eradication. This letter is written to describe a case that posed a diagnostic challenge in our center. A 1-month-old female patient with hydrocephalus secondary to a history of myelomeningocele that required correction at birth with a ventriculoperitoneal (VP) shunt system presented during her prolonged hospitalization with device-associated meningitis due to E. meningoseptica initially susceptible to TMP/SMX MIC <16 µg/L, follow-up cerebrospinal fluid (CSF) cultures remained positive for the same pathogen with TMP/SMX breakthrough resistance acquired (MIC > 64 µg/L) (Table 1). Different antibiotics were tested in vitro and showed resistance to vancomycin, minocycline, and rifampicin, maintaining only susceptibility to ciprofloxacin without achieving eradication with systemic dual high-dose IV therapy. TABLE 1. - Cerebrospinal Fluid Culture Analyzed in Vitek2 System (Biomérieux) Initial Control Antibiotic Value/Interpretation Value/Interpretation Amikacin ≥64 µg/mL (R) ≥64 µg/mL (R) Aztreonam ≥64 µg/mL (R)) Cefazolin ≥64 µg/mL (R) Cefepime ≥64 µg/mL (R) ≥64 µg/mL (R) Ceftazidime ≥64 µg/mL (R) ≥64 µg/mL (R) Ceftriaxone ≥64 µg/mL (R) Ciprofloxacin ≥1 µg/mL (Susceptible) ≥1 µg/mL (S) Gentamicin ≥16 µg/mL (Resistant) ≥16 µg/mL (R) Meropenem ≥64 µg/mL (Resistant) ≥64 µg/mL (R) Piperacillin/tazobactam 32 µg/mL (Susceptible) ≥128 µg/mL (R) Tigecycline 1 µg/mL (S) ≥8 µg/mL (R) Trimethoprim/sulfamethoxazole (TMP/SMX) 40 µg/mL (S) ≥320 µg/mL (R) Colistin ≥16 µg/mL (R) Doripenem ≥8 µg/mL (R) Imipenem ≥16 µg/mL (R) (R), resistant; (S), susceptible. Intraventricular antimicrobial therapy with ciprofloxacin was proposed based on a case report in the literature: 21 days of systemic treatment combined with Intrathecal therapy, and another 21 days of systemic therapy alone. Negative CSF cultures were obtained after 6 days of dual therapy plus intraventricular ciprofloxacin with clinical improvement in the patient and replacement of the VP shunt. Although recent literature suggests that antibiotics such as fluoroquinolones can achieve good concentrations in the CSF fluid after IV administration and do not suggest their use in intraventricular or intrathecal routes,3 and that the FDA has not approved any antimicrobial agent for intraventricular use,3,4 when therapeutic options are limited due to multidrug-resistant pathogens in central nervous system infections, intraventricular/intrathecal antibiotic therapy with fluoroquinolones appears to be a viable option in the absence of other available treatments. More studies are required, particularly in cases, such as the one presented for antibiotics that theoretically achieve adequate CSF concentrations when only IV route is used.

Emergence of Multidrug-Resistant Non-Fermenting Gram-Negative Bacilli in a Tertiary Care Teaching Hospital of Central India: Is Colistin Resistance Still a Distant Threat?

Purpose Multidrug-resistant (MDR) organisms are being increasingly reported from India. This study aimed to determine the antibiotic susceptibility pattern of non-fermenting Gram-negative bacilli (NF-GNB) isolated from all the clinical samples to estimate the prevalence of MDR MDR NF-GNB and to screen for colistin-resistance genes among all colistin-resistant strains. Materials and methods This prospective study conducted from January 2021 to July 2022 at a tertiary care teaching hospital in central India identified MDR NF-GNB from clinical samples using standard procedures and antimicrobial susceptibility testing conducted as per Clinical Laboratory Standards Institute (CLSI) guidelines. Colistin-resistant strains identified by broth microdilution were further subjected to detection of plasmid-mediated colistin-resistant genes (mcr-1, mcr-2, mcr-3) by polymerase chain reaction (PCR). Results A total 2,106 NF-GNB were isolated from 21,019 culture positive clinical samples, of which 743 (35%) were MDR. Majority of MDR NF-GNB isolated were from pus (45.50%) followed by blood (20.50%). Out of 743 non-duplicate MDR non-fermenters,the most common were Pseudomonas aeruginosa (51.7%), Acinetobacter baumannii (23.4%),and others (24.9%).Around5.2% Pseudomonas aeruginosa and 2.3% Acinetobacter baumannii were resistant to colistin, and 88.2% were resistant to ceftazidime. Burkholderia cepacia complexwas 100% susceptible to minocycline and least susceptible to ceftazidime (28.6%). Out of 11, 10 (90.9%) Stenotrophomonas maltophilia were susceptible to colistin and least susceptible to ceftazidime and minocycline (27.3%). All 33 colistin-resistant strains (minimal inhibitory concentration ≥ 4 µg/mL) were found to be negative for mcr-1, mcr-2, and mcr-3 genes. Conclusion Our study showed a significantly wide variety of NF-GNB, ranging from Pseudomonas aeruginosa (51.7%), Acinetobacter baumannii (23.4%),to Acinetobacter haemolyticus (4.6%), Pseudomonas putida (0.9%), Elizabethkingia meningoseptica (0.7%), Pseudomonas luteola (0.5%), and Ralstonia pickettii (0.4%), which have not been commonly reported in literature. Of all the non-fermenters isolated in the present study, 35.28% were MDR, raising the concern for rationalizing antibiotic use and improving infection control measures to avert or slow the emergence of antibiotic resistance.

Insights into Regulating Mechanism of Mutagenesis Strains of Elizabethkingia meningoseptica sp. F2 by Omics Analysis.

Vitamin K2 plays an important role in electron transport, blood coagulation, and calcium homeostasis, and researchers have been trying to use microbes to produce it. Although our previous studies have shown that gradient radiation, breeding, and culture acclimation can improve vitamin K2 production in Elizabethkingia meningoseptica, the mechanism is still unclear. This study is the first which performs genome sequencing of E. meningoseptica sp. F2 as a basis for subsequent experiments and further comparative analyses with other strains. Comparative metabolic pathway analysis of E. meningoseptica sp. F2, E. coli, Bacillus subtilis, and other vitamin K2 product strains revealed that the mevalonate pathway of E. meningoseptica sp. F2 is different in bacteria at the system level. The expressions of menA, menD, menH, and menI in the menaquinone pathway and idi, hmgR, and ggpps in the mevalonate pathway were higher than those in the original strain. A total of 67 differentially expressed proteins involved in the oxidative phosphorylation metabolic pathway and citric acid cycle (TCA cycle) were identified. Our results reveal that combined gradient radiation breeding and culture acclimation can promote vitamin K2 accumulation probably by regulating the vitamin K2 pathway, oxidative phosphorylation metabolism pathway, and the citrate cycle (TCA cycle).