An Elizabethkingia meningoseptica (Chryseobacterium meningosepticum) Outbreak in Intensive Care Units and Infection Control Measures
Yıl: 2022 Cilt: 27 Sayı: 2 Sayfa Aralığı: 209 - 217 Metin Dili: İngilizce DOI: 10.5578/flora.20229804 İndeks Tarihi: 10-08-2022
An Elizabethkingia meningoseptica (Chryseobacterium meningosepticum) Outbreak in Intensive Care Units and Infection Control Measures
Öz: Introduction: Elizabethkingia meningoseptica is an emerging gram-negative opportunistic nosocomial pathogen reported in immunocompromised patients. We aimed to report an outbreak of E. meningoseptica acquisition in the intensive care units (ICUs) of a training and research hospital in Turkey and highlight the infection control measures. Materials and Methods: Bacterial strains were determined using MALDI Biotyper (Bruker Daltonics, Bremen, Germany) minimum inhibitor concentrations were examined using MicroScan automatized system. Results were determined according to the CLSI guidelines. Environmental cultures were obtained and investigated for the presence of E. meningoseptica. Clonal relationships among E. meningoseptica strains were investigated using PFGE. Results: Isolates were obtained from nine critically ill patients’ clinical samples. All strains were resistant to tested antibiotics (amikacin, Amox/Clav, cefepime, cefotaxime, ceftzidime, cefuroxime, ertapenem, gentamycin, meropenem, trimethoprim/sulfamethoxazole (TMP–SMX), imipenem) except for levofloxacin (8/9), ciprofloxacin (5/9), and piperacillin/tazobactam. PFGE indicated that the strains involved in the outbreak were closely related. Conclusion: Intrinsically multiple drug-resistant Elizabethkingia spp. isolates can be a common life-threatening pathogen in ICUs in our country, and prevention is possible through early notification of small-scale outbreaks and necessary infection control measures.
Anahtar Kelime: Yoğun Bakım Ünitelerinde Elizabethkingia meningoseptica (Chryseobacterium meningosepticum) Salgını
Öz: Giriş: Elizabethkingia meningoseptica bağışıklığı baskılanmış hastalarda artan oranda bildirilen Gram negatif fırsatçı hastane infeksiyonu etkenidir. Yoğun bakım ünitelerinden (YBÜ) izole edilen E. meningoseptica suşları arasındaki klonal ilişkiler ve bunların salgınla ilişkisi araştırıldı. Materyal ve Metod: İzolatlar MALDI-TOF kullanılarak tanımlandı (Bruker Dal-tonik GmbH, Bremen, Almanya). Antibiyotik Minimum inhibitör konsantrasyonları, MicroScan otomatize sistem kullanılarak belirlendi. Sonuçlar, Klinik ve Laboratuvar Standartları Enstitüsü kılavuzlarına göre raporlandı. Çevre kültürleri alındı ve E. meningoseptica varlığı açısından araştırıldı. E. meningoseptica suşları arasındaki klonal ilişkiler PFGE kullanılarak araştırıldı. Bulgular: İzolatlar anestezi yoğun bakım ünitesinden iki kadın (62 ve 82 yaşında), bir erkek (58 yaşında) ve koroner yoğun bakım ünitesinden iki kadın (73 ve 60 yaşında), iki erkek (57 ve 75 yaşında) ve dahiliye yoğun bakım ünitesinden iki kadın (65 ve 67 yaşında) hastanın klinik örneklerinden izole edildi. Suşlar levofloksasin (8/9), siprofloksasin (5/9) ve piperasilin/tazobaktam dışında test edilen antibiyotiklere dirençli bulundu. PFGE ile salgına dahil olan suşların yakından ilişkili olduğu gösterildi. Sonuç: Sonuç olarak, çoklu ilaç dirençli Elizabethkingia spp. izolatları ülkemizde yoğun bakım ünitelerinde tesbit edilen ve yaşamı tehdit eden bir patojendir. Salgından korunma küçük çaplı salgınların erken bildirilmesi ve gerekli infeksiyon kontrol önlemlerinin alınmasıyla mümkündür.
Anahtar Kelime: Belge Türü: Makale Makale Türü: Araştırma Makalesi Erişim Türü: Erişime Açık
- 1. Sahu MK, Balasubramaniam UCB, Singh SP, Talwar S. Elizabethkingia Meningoseptica: An emerging nosocomial pathogen causing septicemia in critically Ill patients. Indian J Crit Care Med 2019;23(2):104-5. https://doi. org/10.5005/jp-journals-10071-23127
- 2. Jean SS, Lee WS, Chen FL, Ou TY, Hsueh PR. Elizabethkingia meningoseptica: An important emerging pathogen causing healthcare-associated infections. J Hosp Infect 2014;86(4):244-9. https://doi.org/10.1016/j. jhin.2014.01.009
- 3. King EO. Studies on a group of previously unclassified bacteria associated with meningitis in infants. Am J Clin Pathol 1959;31(3):241-7. https://doi.org/10.1093/ ajcp/31.3.241
- 4. Vandamme P, Bernardet J-F, Segers P, Kersters K, Holmes B. New Perspectives in the Classification of the Flavobacteria: Description of Chryseobacterium gen. nov., Bergeyella gen. nov., and Empedobacter nom. rev. International Journal of Systematic and Evolutionary Microbiology 1994;44(4):827-31. https://doi.org/10.1099/00207713- 44-4-827
- 5. Kim KK, Kim MK, Lim JH, Park HY, Lee ST. Transfer of Chryseobacterium meningosepticum and Chryseobacterium miricola to Elizabethkingia gen. nov. as Elizabethkingia meningoseptica comb. nov. and Elizabethkingia miricola comb. nov. Int J Syst Evol Microbiol 2005;55(Pt 3):1287- 93. https://doi.org/10.1099/ijs.0.63541-0
- 6. Moore LS, Owens DS, Jepson A, Turton JF, Ashworth S, Donaldson H, et al. Waterborne Elizabethkingia meningoseptica in adult critical care. Emerg Infect Dis 2016;22(1):9-17. https://doi.org/10.3201/eid2201.150139
- 7. Chiu CH, Waddingdon M, Greenberg D, Schreckenberger PC, Carnahan AM. Atypical Chryseobacterium meningosepticum and meningitis and sepsis in newborns and the immunocompromised, Taiwan. Emerg Infect Dis 2000;6(5):481- 6. https://doi.org/10.3201/eid0605.000506
- 8. Malik W, McLeod G. Persistent Elizabethkingia meningoseptica bacteremia in a patient with multiple myeloma. IDCases 2019;18:e00617. https://doi.org/10.1016/j. idcr.2019.e00617
- 9. Ghafur A, Vidyalakshmi PR, Priyadarshini K, Easow JM, Raj R, Raja T. Elizabethkingia meningoseptica bacteremia in immunocompromised hosts: The first case series from India. South Asian J Cancer 2013;2(4):211-5. https://doi. org/10.4103/2278-330X.119912
- 10. Ranjan S, Veerappan I, Patil SP, Sethuraman R. Elizabethkingia meningoseptica peritonitis in continuous ambulatory peritoneal dialysis patient: A rare case report with diagnostic challenges. Indian J Pathol Microbiol 2017;60(4):626-8. https://doi.org/10.4103/IJPM.IJPM_28_17
- 11. Lin J-N, Lai C-H, Yang C-H, Huang Y-H. Elizabethkingia infections in humans: From genomics to clinics. Microorganisms 2019;7(9):295. https://doi.org/10.3390/microorganisms7090295
- 12. Seong H, Kim JH, Kim JH, Lee WJ, Ahn JY, M DN, et al. Risk Factors for mortality in patients with Elizabethkingia infection and the clinical impact of the antimicrobial Susceptibility patterns of Elizabethkingia species. J Clin Med 2020;9(5). https://doi.org/10.3390/jcm9051431
- 13. Erinmez M, Büyüktas Manay A, Zer Y. Investigation of an outbreak of Elizabethkingia meningoseptica on a pediatric intensive care unit. GMS Hyg Infect Control 2021;16:Doc19.
- 14. Available from: https://www.eucast.org/fileadmin/ src/media/PDFs/EUCAST_files/Expert_Rules/2020/Intrinsic_ Resistance_and_Unusual_Phenotypes_Tables_ v3.2_20200225.pdf.
- 15. Bellais S, Poirel L, Naas T, Girlich D, Nordmann P. Genetic- biochemical analysis and distribution of the Ambler class A beta-lactamase CME-2, responsible for extended- spectrum cephalosporin resistance in Chryseobacterium (Flavobacterium) meningosepticum. Antimicrob Agents Chemother 2000;44(1):1-9. https://doi.org/10.1128/ AAC.44.1.1-9.2000
- 16. Lin JN, Lai CH, Yang CH, Huang YH. Elizabethkingia infections in humans: From genomics to clinics. Microorganism 2019;7(9). https://doi.org/10.3390/microorganisms7090295
- 17. Ceyhan M, Yildirim I, Tekeli A, Yurdakok M, Us E, Altun B, et al. A Chryseobacterium meningosepticum outbreak observed in 3 clusters involving both neonatal and non-neonatal pediatric patients. Am J Infect Control 2008;36(6):453- 7. https://doi.org/10.1016/j.ajic.2007.09.008
- 18. Weaver KN, Jones RC, Albright R, Thomas Y, Zambrano CH, Costello M, et al. Acute emergence of Elizabethkingia meningoseptica infection among mechanically ventilated patients in a long-term acute care facility. Infect Control Hosp Epidemiol 2010;31(1):54-8. https://doi. org/10.1086/649223
- 19. Han MS, Kim H, Lee Y, Kim M, Ku NS, Choi JY, et al. Relative prevalence and antimicrobial susceptibility of clinical isolates of Elizabethkingia species based on 16S rRNA gene sequencing. J Clin Microbiol 2017;55(1):274-80. https:// doi.org/10.1128/JCM.01637-16
- 20. The Clinical & Laboratory Standards Institute (CLSI) supplement M100 (ISBN 978-1-68440-032-4 (Print); ISBN 978- 1-68440-033-1 Wayne Ph. 2019 29th Edition
- 21. Centers for Disease Control and Prevention. Available from: https://www.cdc.gov/infectioncontrol/guidelines/environmental/ background/sampling.html.
- 22. Erdem F, Oncul O, Aktas Z. Characterization of resistance genes and polymerase chain reaction-based replicon typing in carbapenem-resistant Klebsiella pneumoniae. Microb Drug Resist 2019;25(4):551-7. https://doi.org/10.1089/ mdr.2018.0231
- 23. Chen S, Soehnlen M, Blom J, Terrapon N, Henrissat B, Walker ED. Comparative genomic analyses reveal diverse virulence factors and antimicrobial resistance mechanisms in clinical Elizabethkingia meningoseptica strains. PLoS One 2019;14(10):e0222648. https://doi.org/10.1371/journal. pone.0222648
- 24. Wang J-L, Chen M-L, Lin YE, Chang S-C, Chen Y-C. Association between contaminated faucets and colonization or infection by nonfermenting gram-negative bacteria in intensive care units in Taiwan. Journal of clinical microbiology 2009;47(10):3226-30. https://doi.org/10.1128/ JCM.00034-09
- 25. Balm M, Salmon S, Jureen R, Teo C, Mahdi R, Seetoh T, et al. Bad design, bad practices, bad bugs: frustrations in controlling an outbreak of Elizabethkingia meningoseptica in intensive care units. J Hosp Infect 2013;85(2):134-40. https://doi.org/10.1016/j.jhin.2013.05.012
- 26. Yung CF, Maiwald M, Loo LH, Soong HY, Tan CB, Lim PK, et al. Elizabethkingia anophelis and association with tap water and handwashing, Singapore. Emerg Infect Dis 2018;24(9):1730-3. https://doi.org/10.3201/ eid2409.171843
- 27. Marko DC, Saffert RT, Cunningham SA, Hyman J, Walsh J, Arbefeville S, et al. Evaluation of the Bruker Biotyper and Vitek MS matrix-assisted laser desorption ionization-time of flight mass spectrometry systems for identification of nonfermenting gram-negative bacilli isolated from cultures from cystic fibrosis patients. J Clin Microbiol 2012;50(6):2034-9. https://doi.org/10.1128/JCM.00330-12
- 28. Mirza HC, Tuncer Ö, Ölmez S, Şener B, Tuğcu GD, Özçelik U, et al. Clinical Strains of Chryseobacterium and Elizabethkingia spp. Isolated from pediatric patients in a university hospital: Performance of MALDI-TOF MS-Based identification, antimicrobial susceptibilities, and baseline patient characteristics. Microb Drug Resist 2018;24(6):816-21. https://doi.org/10.1089/mdr.2017.0206
- 29. Lin JN, Lai CH, Yang CH, Huang YH, Lin HF, Lin HH. Comparison of four automated microbiology systems with 16S rRNA gene sequencing for identification of Chryseobacterium and Elizabethkingia species. Sci Rep 2017;7(1):13824. https://doi.org/10.1038/s41598-017-14244-9
- 30. Gales AC, Jones RN, Andrade SS, Sader HS. Antimicrobial susceptibility patterns of unusual nonfermentative gram-negative bacilli isolated from Latin America: Report from the SENTRY Antimicrobial Surveillance Program (1997-2002). Mem Inst Oswaldo Cruz 2005;100(6):571- 7. https://doi.org/10.1590/S0074-02762005000600011
- 31. Jean SS, Hsieh TC, Ning YZ, Hsueh PR. Role of vancomycin in the treatment of bacteraemia and meningitis caused by Elizabethkingia meningoseptica. Int J Antimicrob Agents. 2017;50(4):507-11. https://doi.org/10.1016/j.ijantimicag. 2017.06.021
- 32. Shailaja VV, Reddy AK, Alimelu M, Sadanand LN. Neonatal meningitis by multidrug resistant Elizabethkingia meningosepticum identified by 16S ribosomal RNA gene sequencing. Int J Pediatr 2014;2014:918907. https://doi. org/10.1155/2014/918907
- 33. Peng S-Y, Chen L-K, Wu W-J, Paramita P, Yang P-W, Li Y-Z, et al. Isolation and characterization of a new phage infecting Elizabethkingia anophelis and evaluation of its therapeutic efficacy in vitro and in vivo. Frontiers in Microbiology 2020;11:728. https://doi.org/10.3389/ fmicb.2020.00728
- 34. Chan JC, Chong CY, Thoon KC, Tee NWS, Maiwald M, Lam JCM, et al. Invasive paediatric Elizabethkingia meningoseptica infections are best treated with a combination of piperacillin/ tazobactam and trimethoprim/sulfamethoxazole or fluoroquinolone. J Med Microbiol 2019;68(8):1167-72. https://doi.org/10.1099/jmm.0.001021
- 35. Tenover FC, Arbeit RD, Goering RV, Mickelsen PA, Murray BE, Persing DH, et al. Interpreting chromosomal DNA restriction patterns produced by pulsed-field gel electrophoresis: criteria for bacterial strain typing. J Clin Microbiol 1995;33(9):2233-9. https://doi.org/10.1128/ jcm.33.9.2233-2239.1995
- 36. Chang YC, Lo HH, Hsieh HY, Chang SM. Identification and epidemiological relatedness of clinical Elizabethkingia meningoseptica isolates from central Taiwan. J Microbiol Immunol Infect 2014;47(4):318-23. https://doi. org/10.1016/j.jmii.2013.03.007
- 37. Güngör S, Ozen M, Akinci A, Durmaz R. A Chryseobacterium meningosepticum outbreak in a neonatal ward. Infect Control Hosp Epidemiol 2003;24(8):613-7. https://doi. org/10.1086/502261
| APA | Erdem F, bozok t, kalaycı y, Meral Ocal M, Ünal N, KÖKSAL f (2022). An Elizabethkingia meningoseptica (Chryseobacterium meningosepticum) Outbreak in Intensive Care Units and Infection Control Measures. , 209 - 217. 10.5578/flora.20229804 |
| Chicago | Erdem Fatma,bozok taylan,kalaycı yıldız,Meral Ocal Melda,Ünal Nevzat,KÖKSAL fatih An Elizabethkingia meningoseptica (Chryseobacterium meningosepticum) Outbreak in Intensive Care Units and Infection Control Measures. (2022): 209 - 217. 10.5578/flora.20229804 |
| MLA | Erdem Fatma,bozok taylan,kalaycı yıldız,Meral Ocal Melda,Ünal Nevzat,KÖKSAL fatih An Elizabethkingia meningoseptica (Chryseobacterium meningosepticum) Outbreak in Intensive Care Units and Infection Control Measures. , 2022, ss.209 - 217. 10.5578/flora.20229804 |
| AMA | Erdem F,bozok t,kalaycı y,Meral Ocal M,Ünal N,KÖKSAL f An Elizabethkingia meningoseptica (Chryseobacterium meningosepticum) Outbreak in Intensive Care Units and Infection Control Measures. . 2022; 209 - 217. 10.5578/flora.20229804 |
| Vancouver | Erdem F,bozok t,kalaycı y,Meral Ocal M,Ünal N,KÖKSAL f An Elizabethkingia meningoseptica (Chryseobacterium meningosepticum) Outbreak in Intensive Care Units and Infection Control Measures. . 2022; 209 - 217. 10.5578/flora.20229804 |
| IEEE | Erdem F,bozok t,kalaycı y,Meral Ocal M,Ünal N,KÖKSAL f "An Elizabethkingia meningoseptica (Chryseobacterium meningosepticum) Outbreak in Intensive Care Units and Infection Control Measures." , ss.209 - 217, 2022. 10.5578/flora.20229804 |
| ISNAD | Erdem, Fatma vd. "An Elizabethkingia meningoseptica (Chryseobacterium meningosepticum) Outbreak in Intensive Care Units and Infection Control Measures". (2022), 209-217. https://doi.org/10.5578/flora.20229804 |
| APA | Erdem F, bozok t, kalaycı y, Meral Ocal M, Ünal N, KÖKSAL f (2022). An Elizabethkingia meningoseptica (Chryseobacterium meningosepticum) Outbreak in Intensive Care Units and Infection Control Measures. Flora İnfeksiyon Hastalıkları ve Klinik Mikrobiyoloji Dergisi, 27(2), 209 - 217. 10.5578/flora.20229804 |
| Chicago | Erdem Fatma,bozok taylan,kalaycı yıldız,Meral Ocal Melda,Ünal Nevzat,KÖKSAL fatih An Elizabethkingia meningoseptica (Chryseobacterium meningosepticum) Outbreak in Intensive Care Units and Infection Control Measures. Flora İnfeksiyon Hastalıkları ve Klinik Mikrobiyoloji Dergisi 27, no.2 (2022): 209 - 217. 10.5578/flora.20229804 |
| MLA | Erdem Fatma,bozok taylan,kalaycı yıldız,Meral Ocal Melda,Ünal Nevzat,KÖKSAL fatih An Elizabethkingia meningoseptica (Chryseobacterium meningosepticum) Outbreak in Intensive Care Units and Infection Control Measures. Flora İnfeksiyon Hastalıkları ve Klinik Mikrobiyoloji Dergisi, vol.27, no.2, 2022, ss.209 - 217. 10.5578/flora.20229804 |
| AMA | Erdem F,bozok t,kalaycı y,Meral Ocal M,Ünal N,KÖKSAL f An Elizabethkingia meningoseptica (Chryseobacterium meningosepticum) Outbreak in Intensive Care Units and Infection Control Measures. Flora İnfeksiyon Hastalıkları ve Klinik Mikrobiyoloji Dergisi. 2022; 27(2): 209 - 217. 10.5578/flora.20229804 |
| Vancouver | Erdem F,bozok t,kalaycı y,Meral Ocal M,Ünal N,KÖKSAL f An Elizabethkingia meningoseptica (Chryseobacterium meningosepticum) Outbreak in Intensive Care Units and Infection Control Measures. Flora İnfeksiyon Hastalıkları ve Klinik Mikrobiyoloji Dergisi. 2022; 27(2): 209 - 217. 10.5578/flora.20229804 |
| IEEE | Erdem F,bozok t,kalaycı y,Meral Ocal M,Ünal N,KÖKSAL f "An Elizabethkingia meningoseptica (Chryseobacterium meningosepticum) Outbreak in Intensive Care Units and Infection Control Measures." Flora İnfeksiyon Hastalıkları ve Klinik Mikrobiyoloji Dergisi, 27, ss.209 - 217, 2022. 10.5578/flora.20229804 |
| ISNAD | Erdem, Fatma vd. "An Elizabethkingia meningoseptica (Chryseobacterium meningosepticum) Outbreak in Intensive Care Units and Infection Control Measures". Flora İnfeksiyon Hastalıkları ve Klinik Mikrobiyoloji Dergisi 27/2 (2022), 209-217. https://doi.org/10.5578/flora.20229804 |
