Susceptibility of Elizabethkingia spp. to commonly tested and novel antibiotics and concordance between broth microdilution and automated testing methods

Abstract

Objectives: We aimed to determine susceptibilities of Elizabethkingia spp. to 25 commonly tested and 8 novel antibiotics, and to compare the performance of different susceptibility testing methods.

Methods: Clinical isolates of Elizabethkingia spp., Chryseobacterium spp. and Flavobacterium spp. collected during 2002-18 (n = 210) in a nationwide surveillance programme in Taiwan were speciated by 16S rRNA sequencing. MICs were determined by broth microdilution. The broth microdilution results of 18 common antibiotics were compared with those obtained by the VITEK 2 automated system.

Results: Among the Elizabethkingia spp. identified (n = 108), Elizabethkingia anophelis was the most prevalent (n = 90), followed by Elizabethkingia meningoseptica (n = 7) and Elizabethkingia miricola cluster [E. miricola (n = 6), Elizabethkingia bruuniana (n = 3) and Elizabethkingia ursingii (n = 2)]. Most isolates were recovered from respiratory or blood specimens from hospitalized, elderly patients. PFGE showed two major and several minor E. anophelis clones. All isolates were resistant to nearly all the tested β-lactams. Doxycycline, minocycline and trimethoprim/sulfamethoxazole inhibited >90% of Elizabethkingia spp. Rifampin inhibited E. meningoseptica (100%) and E. anophelis (81.1%). Fluoroquinolones and tigecycline were active against E. meningoseptica and E. miricola cluster isolates. Novel antibiotics, including imipenem/relebactam, meropenem/vaborbactam, ceftazidime/avibactam, cefepime/zidebactam, delafloxacin, eravacycline and omadacycline were ineffective but lascufloxacin inhibited half of Elizabethkingia spp. The very major discrepancy rates of VITEK 2 were >1.5% for ciprofloxacin, moxifloxacin and vancomycin. Major discrepancy rates were >3% for amikacin, tigecycline, piperacillin/tazobactam and trimethoprim/sulfamethoxazole.

Conclusions: MDR, absence of standard interpretation criteria and poor intermethod concordance necessitate working guidelines to facilitate future research of emerging Elizabethkingia spp.

Figure 1.

Susceptibility of Elizabethkingia spp. to commonly tested antibiotics. In the absence of CLSI breakpoints, susceptibility criteria were adapted from previous studies and are listed in Table S2. The commonly tested antibiotics for which <5% of all Elizabethkingia spp. were susceptible are not shown in Figure 1; refer to Table S4 for their susceptibility. They included cefepime, cefotaxime, ceftazidime, doripenem, imipenem, meropenem, ampicillin/sulbactam, ticarcillin/clavulanic acid, vancomycin, colistin, polymyxin B, tobramycin, tetracycline and aztreonam. AMK, amikacin; GEN, gentamicin; TZP, piperacillin/tazobactam; CIP, ciprofloxacin; LVX, levofloxacin; MFX, moxifloxacin; DOX, doxycycline; MIN, minocycline; TGC, tigecycline; RIF, rifampin; SXT, trimethoprim/sulfamethoxazole.

Figure 2.

Susceptibility of Elizabethkingia spp. to novel antibiotics. Due to the lack of CLSI breakpoints, susceptibility criteria were adapted from previous studies and are listed in Table S3. LCF, lascufloxacin; DFX, delafloxacin; CZA, ceftazidime/avibactam; FPZ, cefepime/zidebactam; IMR, imipenem/relebactam; MEV, meropenem/vaborbactam; OMC, omadacycline; ERV, eravacycline.