Neonatal bacteremia and meningitis caused by Elizabethkingia, treatment and challenge: a case report and literature review

Elizabethkingia is a gram-negative, rod-shaped bacterial genus that is commonly detected in the environment (particularly in soil and water), but it rarely causes human infection; however, following an increased incidence of Elizabethkingia infections among patients in adulthood, pediatric and neonatal intensive care units, since 2004. Elizabethkingia is considered an emerging pathogen in hospital settings, and it has been linked to outbreaks due to contaminated medical equipment. Moreover, this infection can also be a pathogen causing neonatal sepsis which is associated with high rates of morbidity and mortality, including potential long-term neurological complications. Early recognition as well as identification of appropriate, often prolonged, combination of antibiotic therapy is essential in managing such infections. In our report, we present a case of acute meningitis caused by E. meningoseptica in a premature baby 33 weeks of gestational age, admitted to our pediatric word at the 13 days old as a case of neonatal fever, with past history of 18 hours PROM and oligohydramnios. The organism is identified through blood and cerebrospinal fluid cultures. For the treatment of this infection, we started on triple antibiotic therapy (Rifampicin, vancomycin and trimethoprim/sulphamethoxazole) due to known multidrug resistance to many standard antibiotic regimens, making treatment challenging mainly in preterm babies and immunocompromised children. In conclusion, effective management of multidrug resistant bacteria such Elizabethkingia requires a multidisciplinary approach, including intensive care support (in some cases), and coordination with infection control teams to prevent further transmission and improve the outcome.