Meningitis and sepsis due to multidrug-resistant Elizabethkingia meningoseptica in a premature neonate

Abstract

Elizabethkingia meningoseptica is known to cause meningitis in premature neonates and severe infections in immunocompromised adults. It may cause a therapeutic dilemma as it often shows discrepancies between various methods of antimicrobial susceptibility testing. Here, we present a case of multi drug resistant E. meningoseptica meningitis and sepsis in a premature baby, which caused a therapeutic challenge. The strain was susceptible to piperacillin, piperacillin-tazobactam and trimethoprim/sulfamethoxazole by disk diffusion method. On the other hand the minimum inhibitory concentration values for these antibiotics were much higher to be interpreted as resistant by VITEK 2C (bioMérieux). This case showed significant clinical improvement with combination therapy of piperacillin-tazobactam and amikacin, and the same drugs were continued. Relying on the clinical outcome in this case, we observe that VITEK 2C may be less accurate than disk diffusion method for detection of antimicrobial resistance in this organism.

Keywords

Elizabethkingia meningoseptica - meningitis - sepsis - premature neonate - disk diffusion - VITEK 2C