From the Guidelines
Treatment for Elizabethkingia infections should be guided by the most recent and highest quality evidence, which suggests using a combination of antibiotics such as piperacillin/tazobactam, cefepime, or meropenem, with consideration of adding vancomycin or rifampin in severe cases or for immunocompromised patients. The choice of empiric antibiotic regimens should be based on the clinical condition of the patients, the individual risk for infection by resistant pathogens, and the local resistance epidemiology 1.
Key Considerations
- Elizabethkingia infections are challenging to treat due to the bacteria's multidrug resistance, making early identification and targeted therapy essential for successful outcomes.
- Combination antibiotic therapy is typically required, with the recommended approach including broad-spectrum antibiotics such as piperacillin/tazobactam 4.5 g 6-hourly, or cefepime 2 g 8-hourly + metronidazole 500 mg 6-hourly, or meropenem 1 g 8-hourly 1.
- In severe cases, a three-drug regimen might be necessary, potentially adding vancomycin or rifampin.
- Treatment duration generally ranges from 14 to 21 days, depending on infection severity and patient response.
- Antibiotic susceptibility testing is crucial before initiating therapy, as resistance patterns vary among Elizabethkingia strains.
Supportive Care
- Supportive care addressing fever, maintaining hydration, and managing complications is also important.
- For immunocompromised patients or those with indwelling medical devices, more aggressive treatment and device removal (if present) may be necessary.
- The use of carbapenems should be limited to preserve the activity of this class of antibiotics due to the concern of emerging carbapenem-resistance 1.
Emerging Therapies
- New antibiotics such as ceftolozone/tazobactam and ceftazidime/avibactam have been approved for treatment of complicated intra-abdominal infections, including infections by ESBL-producing Enterobacteriaceae and P. aeruginosa, and may be valuable for treating infections caused by MDR gram-negative bacteria 1.
From the Research
Treatment Options for Elizabethkingia Infections
The treatment of Elizabethkingia infections is challenging due to the bacterium's multidrug-resistant phenotype. However, several studies have investigated the effectiveness of various antibiotics against Elizabethkingia species.
- The majority of Elizabethkingia species isolates were susceptible to minocycline and rifampin 2.
- Vancomycin, rifampicin, newer fluoroquinolones, piperacillin-tazobactam, minocycline, and possibly tigecycline are preferred empirical choices for Elizabethkingia infection according to in-vitro susceptibility data 3.
- Fluoroquinolone treatment has been associated with lower 14-day mortality compared to non-fluoroquinolone treatment in patients with Elizabethkingia meningoseptica bacteraemia 4.
- Combination therapy, including systemic and intraventricular therapy, has been used to treat Elizabethkingia meningoseptica neonatal meningitis 5.
Antibiotic Susceptibility Patterns
The antibiotic susceptibility patterns of Elizabethkingia species vary, but some studies have reported the following susceptibility rates:
- Elizabethkingia meningoseptica: sensitive to piperacillin-tazobactam (5-100%), ciprofloxacin (0-43.4%), levofloxacin (30-81.8%), trimethoprim-sulfamethoxazole (0-100%), tigecycline (15-100%), minocycline (60-100%), and rifampicin (94-100%) 2.
- Elizabethkingia anophelis: sensitive to piperacillin-tazobactam (3.3-93.3%), ciprofloxacin (1-75%), levofloxacin (12-100%), trimethoprim-sulfamethoxazole (1.02-96.7%), tigecycline (0-52.2%), minocycline (97.5-100%), and rifampicin (20.5-96%) 2.
- Elizabethkingia miricola: sensitive to piperacillin-tazobactam (41.6-94.0%), ciprofloxacin (14-75%), levofloxacin (77.0-100%), trimethoprim-sulfamethoxazole (18.0-100%), tigecycline (50%), minocycline (100%), and rifampicin (66-85.7%) 2.
Risk Factors for Mortality
Several risk factors for mortality have been identified in patients with Elizabethkingia infections, including:
- Intensive care unit admission
- The need for mechanical ventilation
- Immunosuppressive or steroid therapy use
- Pneumonia
- Comorbid liver disease
- The use of inappropriate antimicrobial therapy 6.