Waterborne Elizabethkingia meningoseptica in Adult Critical Care

Abstract

Elizabethkingia meningoseptica is an infrequent colonizer of the respiratory tract; its pathogenicity is uncertain. In the context of a 22-month outbreak of E. meningoseptica acquisition affecting 30 patients in a London, UK, critical care unit (3% attack rate) we derived a measure of attributable morbidity and determined whether E. meningoseptica is an emerging nosocomial pathogen. We found monomicrobial E. meningoseptica acquisition (n = 13) to have an attributable morbidity rate of 54% (systemic inflammatory response syndrome ≥2, rising C-reactive protein, new radiographic changes), suggesting that E. meningoseptica is a pathogen. Epidemiologic and molecular evidence showed acquisition was water-source-associated in critical care but identified numerous other E. meningoseptica strains, indicating more widespread distribution than previously considered. Analysis of changes in gram-negative speciation rates across a wider London hospital network suggests this outbreak, and possibly other recently reported outbreaks, might reflect improved diagnostics and that E. meningoseptica thus is a pseudo-emerging pathogen.

Keywords: Chryseobacterium meningosepticum; Elizabethkingia meningoseptica; Flavobacterium meningosepticum; Matrix-assisted laser desorption/ionization time-of-flight; United Kingdom; adults; antimicrobial drug resistance; intensive care; water.

Figure 1

Pulsed-field gel electrophoresis profiles of XbaI-digested genomic DNA from patient (P) and environmental (E) Elizabethkingia meningoseptica isolates from an outbreak in an adult critical care unit, London, UK, 2012–2013. Two additional isolates from patients demonstrated unique pulsed-field gel electrophoresis profiles and are not shown. Patient numbers (e.g., P9) match those given in Table 1.

Figure 2

Clinicophysiologic parameters of patients with monomicrobial acquisition of Elizabethkingia meningoseptica in an outbreak in an adult critical care unit, London, UK, 2012–2013. Thirteen patients in the outbreak cohort were identified as having monomicrobial E. meningoseptica acquisition. Of these, 8 patients demonstrated an increase in 5 clinicophysiologic parameters of inflammation during the 48 hours before and after acquisition of E. meningoseptica: A) body temperature; B) oxygen saturation; C) pulse rate; D) lymphocyte count; and D) C-reactive protein. Patient numbers match those given in Table 1.