Epidemiology, clinical profiles, and antimicrobial susceptibility of Elizabethkingia meningoseptica infections: Insights from a tertiary care hospital in Saudi Arabia

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Figure 1
- Previous interventions within one-month prior the infection (n=55).
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Figure 2
- The antibiotic susceptibility of Elizabethkingia meningoseptica isolates.

Table 1

- The incidence of Elizabethkingia meningoseptica over the years (2014-mid 2022).

Years	Number of admissions	E. meningoseptica cases	Incidence rate per 1000 admissions
2014	20,093 (10.0)	3 (4.5)	0.1
2015	19,764 (10.0)	7 (10.6)	0.4
2016	20,514 (10.0)	20 (30.3)	1
2017	21,116 (10.0)	10 (15.2)	0.5
2018	22,539 (11.0)	11 (16.7)	0.5
2019	26,280 (13.0)	5 (7.6)	0.2
2020	23,235 (11.0)	3 (4.5)	0.1
2021	28,260 (14.0)	5 (7.6)	0.2
Mid-2022	22,625 (11.0)	2 (3.0)	0.1
Overall	204,426 (100)	66 (100)	0.3

Table 2

- Characteristics of study participants (N=66).

Characteristics	n (%)
Gender
Female	31 (47.0)
Male	35 (53.0)
Age group
Pediatrics aged ≤14 years	35 (53.0)
Adults aged ≥15 years	31 (47.0)
Age at infection for patients aged ≤14 years (n=35)	0.4 (0.25-2)
Age at infection for patients aged ≥15 years (n=31)	51 (36-62)
Origin of infection
Community-acquired	13 (19.7)
Hospital-acquired	53 (80.3)
Time between admission and positive culture (days)	17 (6-37)
Admission location for hospital-acquired (n=53)
General ward	1 (1.9)
Critical care areas (ICU, OR, and ER)	52 (98.1)
Previous hospitalization^{^†}	48 (72.7)
Previous ICU admission^{^†}	36 (75.0)
Underlying disease
Metabolic disease	4 (6.1)
Prematurity	5 (7.6)
Solid tumors	5 (7.6)
Seizure disorder	5 (7.6)
Cerebrovascular disease	7 (10.6)
Diabetes	7 (10.6)
Hypertension	11 (16.7)
Renal disease	12 (18.2)
Hematology/oncology	14 (21.2)
Immunodeficiency	16 (24.2)
Liver disease	16 (24.2)
Cardiovascular disease	26 (39.4)
Respiratory disease	27 (40.9)
Stem cell transplant	7 (10.6)
Solid organ transplant	13 (19.7)
Previous infection^{^†}	38 (57.6)
Bacteria	32 (84.2)
Fungus	16 (42.1)
Previous antimicrobial use^{^†}	55 (83.3)
Previous medications
Immunosuppressant therapy	20 (30.3)
Chemotherapy	7 (10.6)
Clinical presentation
Colonization	5 (7.6)
Infection	61 (92.4)
Symptoms for cases with infection presentation (n=61)
Fever	20 (32.8)
Tachycardia	21 (34.4)
Hypotension	14 (23)
Respiratory distress	28 (45.9)
Lethargy	11 (18)
Gastrointestinal symptoms	4 (6.6)

Values are presented as numbers and percentages (%) or median and interquartile range (IQR).
↵^† Within one month before the episode (infection).
ICU: intensive care unit, OR: operation room, ER: emergency room

Table 3

- Investigations and hospital course.

Investigations	n (%)
Diagnosis
Blood culture	6 (9.1)
Drainage fluid culture	3 (4.5)
Tracheal aspirate	51 (77.3)
Urine culture	3 (4.5)
Vascular tip culture	1 (1.5)
Wound culture	2 (3.0)
Polymicrobial infection at the time of the episode^*	42 (63.6)
Bacteria	40 (95.2)
Fungus	12 (28.6)
Lab results
Leukopenia	19 (19.8)
Anemia	54 (81.8)
Thrombocytopenia	32 (48.5)
Neutropenia	3 (4.5)
Procalcitonin levels (>0.25 ng/mL)	35 (53.53)
C-reactive protein levels (>50 mg/L)	18 (27.3)
Received target antimicrobial treatment	43 (65.2)
Monotherapy	35 (81.4)^{^†}
Trimethoprim/sulfamethoxazole	10 (23.3)^{^†}
Ciprofloxacin	20 (46.5)^{^†}
Levofloxacin	2 (4.7)^{^†}
Meropenem	1 (2.3)^{^†}
Imipenem	2 (4.7)^{^†}
Combination therapy	8 (18.6)^{^†}
Trimethoprim/sulfamethoxazole + levofloxacin	2 (4.7)^{^†}
Trimethoprim/sulfamethoxazole + ciprofloxacin	4 (9.3)^{^†}
Trimethoprim/sulfamethoxazole + tigecycline	1 (2.3)^{^†}
Gentamycin + trimethoprim/sulfamethoxazole + levofloxacin + minocycline	1 (2.3)^†
Antimicrobial treatment period (days) (n=43)	20 (14-29)
Outcome
Recovered	39 (59.1)
Died	23 (34.8)
Relapsed (while on treatment)	2 (3.0)
Recurrence (within one month)	2 (3.0)
Days from the episode to death (n=23)	17 (5-41)
28-day mortality	15 (22.7)

Values are presented as numbers and percentages (%) or median and interquartile range (IQR).
↵* A total of 10 patients had both bacteria and fungi.
↵^† Percentages were calculated using 43 (number of patients who were on treatment) as a denominator.

Table 4

- Clinical characteristics by age group (N=66).

Clinical features	Pediatrics (n=35)	Adults (n=31)	P-values
Male gender	20 (57.1)	15 (48.4)	0.622
Hospital-acquired infection	27 (77.1)	26 (83.9)	0.549
Previous hospitalization^*	22 (62.9)	26 (83.9)	0.095
Previous ICU admission^*	16 (45.7)	20 (64.5)	0.751
Respiratory disease	15 (42.9)	12 (38.7)	0.805
Cardiovascular disease	18 (51.4)	8 (25.8)	0.045^{^†}
Previous infection^*	15 (42.9)	23 (74.2)	0.013^{^†}
Previous antimicrobial use^*	28 (80)	27 (87.1)	0.521
Previous mechanical ventilation^*	16 (45.7)	25 (80.6)	0.005^{^†}
Colonized infection	2 (5.7)	3 (9.7)	0.659
Polymicrobial infection	21 (60)	21 (67.7)	0.611
Intubation^*	13 (37.1)	19 (61.3)	0.083
Immunosuppressive therapy	4 (11.4)	16 (51.6)	0.000^{^†}
Chemotherapy	2 (5.7)	5 (16.1)	0.240
Stem cell/solid organ transplant	7 (20)	13 (41.9)	0.065
Leukopenia	6 (17.1)	7 (22.6)	0.758
Anemia	25 (71.4)	29 (93.5)	0.026^{^†}
Thrombocytopenia	17 (48.6)	15 (48.4)	1.000
Procalcitonin levels (>0.25 ng/mL)	17 (48.6)	18 (58.1)	0.469
C-reactive protein levels (>50 mg/L)	9 (25.7)	9 (29.0)	0.789
28-day mortality	5 (14.3)	10 (32.3)	0.140
In-hospital mortality	6 (17.1)	17 (54.8)	0.002^{^†}