Clinical case of acute purulent empyema caused by Elizabethkingia anopheles

Acute purulent pleural empyema is a severe post-surgical complication, typically caused by common pathogens. However, rare opportunistic bacteria such as Elizabethkingia anophelis can lead to severe infections that are difficult to treat due to broad antibiotic resistance. We analyzed clinical data of a 69-year-old male patient with pleural empyema following lung lobectomy. Staged interventions were performed (endobronchial valve occlusion, thoracoscopic pleural sanitation, open thoracostomy) alongside advanced microbiological examinations (pathogen identification by MALDI-ToF MS and susceptibility testing according to EUCAST criteria). Standard empirical antimicrobial therapy (meropenem, metronidazole) was ineffective. E. anophelis, resistant to most antibiotics, was isolated from the pleural exudate. Early accurate identification of the rare pathogen E. anophelis and a multimodal treatment strategy (adequate pleural drainage with combined antibiotic therapy) led to a successful outcome, highlighting the importance of timely diagnosis and a multidisciplinary approach.