The emergence of Elizabethkingia meningoseptica infections in a quaternary-level paediatric intensive care unit in Durban, South Africa

Abstract

Background. Elizabethkingia meningoseptica is an emerging pathogen in adult intensive care settings, but there are limited data on infections in children.
Objective. To describe the clinical presentation, risk factors for acquisition and management of infection in a quaternary-level paediatric intensive care unit (PICU).

Methods. This was a retrospective observational analysis of E. meningoseptica infections at the Inkosi Albert Luthuli Central Hospital, Durban, from January 2017 to December 2019.
Results. Eleven cases were identified, of which seven formed part of an outbreak cluster over an 11-week period. Enhanced infection control was implemented after the seventh case had been identified, resulting in immediate control. E. meningoseptica was identified exclusively from endotracheal aspirates. The clonality of outbreak isolates was confirmed from genotypic analysis. Five patients (45.4%) presented with nosocomial ventilator-associated pneumonia or systemic inflammatory response syndrome; one patient had possible meningitis. All patients were mechanically ventilated, with infection developing within 2 - 21 days. Exposure to multiple broad-spectrum antimicrobials (median: 5, range: 2 - 8) was identified as an acquisition risk. Seven of the nine patients who received targeted antimicrobial therapy survived. Of the untreated cases, one was discharged and the other died before isolate results were received. Overall, three patients (27%) demised.

Conclusion. E. meningoseptica infection is emerging as a potential cause of nosocomial pneumonia in the PICU setting, which may also extend to other paediatric critical care settings. Excessive antimicrobial use is a likely risk factor for acquisition. Effective infection control measures remain a cornerstone of limiting nosocomial spread.