# Elizabethkingia meningoseptica With Targeted Environmental Surveillance in a Tertiary Care Hospital: A Retrospective Cohort Study

## TL;DR

This study examines E. meningoseptica infections in ICU/NICU patients, highlighting high antibiotic resistance and mortality, and identifies a NICU sink as a potential environmental source.

## Contribution

The study identifies a NICU sink as a potential reservoir for E. meningoseptica and evaluates antimicrobial susceptibility patterns in a clinical cohort.

## Key findings

- E. meningoseptica isolates showed high resistance to carbapenems and third-generation cephalosporins.
- Minocycline, vancomycin, and fluoroquinolones demonstrated the highest susceptibility among tested antibiotics.
- Environmental surveillance identified E. meningoseptica in one NICU sink out of 98 samples tested.

## Abstract

Introduction

Elizabethkingia meningoseptica (E. meningoseptica​​​) ​​​is a multidrug-resistant, non-fermenting Gram-negative bacillus increasingly associated with nosocomial infections, particularly in immunocompromised and critically ill patients. Its intrinsic resistance to multiple antibiotics limits treatment options and contributes to adverse clinical outcomes.

Aim and objective

The study aimed to investigate the clinical and microbiological characteristics of E. meningoseptica infections among ICU/NICU patients and to explore potential environmental sources through hospital-based surveillance. The objectives of this study were to describe the clinical and demographic profiles of ICU/NICU patients with E. meningoseptica infection; to assess the associated risk factors contributing to these infections; to analyze the antimicrobial susceptibility patterns of the isolated strains using standardized microbiological methods; to evaluate treatment outcomes including morbidity, mortality, and duration of ICU/NICU stay; and to identify potential environmental reservoirs of E. meningoseptica through surveillance activities coordinated by the Hospital Infection Control Committee (HICC).

Methods

A retrospective cohort study was conducted over 18 months (July 2023 to October 2024) at a tertiary care hospital. A total of 15 patients with culture-confirmed E. meningoseptica infection were included. Demographic, clinical, microbiological, and treatment data were collected. Identification and antimicrobial susceptibility testing were performed using the Vitek-2 automated identification system (bioMérieux, Marcy-l'Étoile, France). HICC conducted routine and targeted environmental sampling as per policy protocol.

Results

Among the 15 patients with E. meningoseptica infection, nine (60.0%) were adults, and 11 (73.3%) were male individuals. Sepsis was reported in nine (60.0%), and both ventilator-associated pneumonia and septic shock occurred in six patients each (40.0%). Hypertension and diabetes mellitus were present in six (40.0%) and three (20.0%) patients, respectively. Two neonates (13.3%) with low birth weight and prematurity required NICU admission. Outcomes included mortality in six patients (40.0%), discharge in five (33.3%), and four (26.7%) leaving against medical advice. Endotracheal secretions were the most frequent specimen (46.7%), followed by tracheostomy secretions (33.3%) and blood cultures (13.3%).

All isolates (100%) were resistant to carbapenems, third-generation cephalosporins, aztreonam, and piperacillin-tazobactam. Resistance to gentamicin, colistin, and cotrimoxazole was observed in 73.3%, 66.7%, and 46.7% of isolates, respectively. Highest susceptibility was seen with minocycline (66.7%), vancomycin (60.0%), and fluoroquinolones (53.3%).

Environmental surveillance, conducted from January to March 2023 as part of routine as well as targeted HICC monitoring (as an outbreak of suspected pathogens was suspected from the NICU and ICU), included 98 samples from high-risk ICU/NICU sites such as sinks, ventilators, humidifiers, and suction units. E. meningoseptica was identified in one sample (1.02%), isolated from a NICU sink.

Conclusion

E. meningoseptica infections are associated with high resistance and mortality. Minocycline, vancomycin, and fluoroquinolones may be effective. Early detection, targeted therapy, and HICC-led surveillance are essential for control.