Elizabethkingia meningoseptica in Neonates: Insights from a NICU Outbreak in Northern India

Abstract

Background

Elizabethkingia meningoseptica is an aerobic, Gram-negative bacterium commonly found in the environment and has emerged as a significant nosocomial pathogen, particularly in neonatal intensive care units (NICUs). It predominantly affects premature and immunocompromised neonates, causing meningitis, bacteremia, and pneumonia. The organism’s resistance to common antibiotics poses a challenge for effective treatment, with high mortality and long-term morbidity rates, including hydrocephalus and developmental delays.

Clinical Description

This case series aims to highlight the clinical-laboratory profile, antibiotic resistance patterns, complications, and outcomes of neonatal meningitis caused by E. meningoseptica in a NICU setting, with a review of the literature. The case series includes six neonates with suspected or confirmed E. meningoseptica meningitis, spanning gestational ages from 29+1 weeks to 39 weeks. Clinical presentations varied, including poor feeding, lethargy, apnea, seizures, and fever.

Management and Outcome

All neonates were identified with E. meningoseptica infection either through blood or cerebrospinal fluid (CSF) analysis. Blood and CSF culture antibiotic susceptibility showed sensitivity/intermediate sensitivity to levofloxacin, minocycline, ciprofloxacin, and cefoperazone-sulbactam. Complications included hydrocephalus and seizures.

Summary

E. meningoseptica represents a significant neonatal pathogen with a high risk of neurological complications and mortality, especially in preterm neonates. The pathogen’s resistance to common antibiotics complicates treatment, emphasizing the need for timely diagnosis and tailored antibiotic therapy. This case series provides critical insights into the management of a sustained outbreak despite rigorous infection control measures and underscores the persistent challenges in environmental source identification. Therefore, early identification, appropriate treatment, and effective infection control are essential for improving neonatal outcomes in affected NICUs. Further research is also needed to refine treatment protocols and reduce long-term complications in affected neonates.