From the Guidelines
The treatment for Elizabethkingia MDR ventilator-associated pneumonia typically involves combination antimicrobial therapy with fluoroquinolones, rifampin, and trimethoprim-sulfamethoxazole. A recommended regimen includes ciprofloxacin (400mg IV every 8 hours), rifampin (600mg IV or oral daily), and trimethoprim-sulfamethoxazole (5mg/kg of trimethoprim component IV every 8 hours) 1. Treatment duration is generally 14-21 days, depending on clinical response. Susceptibility testing is crucial as Elizabethkingia demonstrates resistance to many antibiotics including carbapenems, aminoglycosides, and most beta-lactams. Alternative agents that may be effective include minocycline (100mg IV every 12 hours), tigecycline (100mg IV loading dose followed by 50mg every 12 hours), or piperacillin-tazobactam (4.5g IV every 6 hours) if susceptible 1. Supportive care measures should include optimizing ventilator settings, implementing VAP bundles, and ensuring adequate drainage of respiratory secretions. Elizabethkingia infections are challenging to treat due to intrinsic resistance mechanisms including efflux pumps, beta-lactamases, and biofilm formation, which is why combination therapy targeting multiple mechanisms is often necessary for successful treatment. Some studies suggest that aerosolized antibiotics may have value as adjunctive therapy in patients with VAP due to some MDR pathogens 1. However, the use of aerosolized antibiotics is not universally recommended and should be considered on a case-by-case basis. It is also important to note that the treatment of Elizabethkingia MDR VAP should be guided by local antimicrobial susceptibility patterns and should be tailored to the individual patient's needs. In general, the treatment of Elizabethkingia MDR VAP requires a multidisciplinary approach, including infectious disease specialists, pulmonologists, and critical care specialists, to ensure the best possible outcomes.
From the Research
Treatment for Elizabethkingia (Multidrug-Resistant) MDR Ventilator-Associated Pneumonia (VAP)
- The treatment for Elizabethkingia (Multidrug-Resistant) MDR Ventilator-Associated Pneumonia (VAP) is challenging due to its intrinsic resistance to multiple antibiotics 2, 3.
- There is limited data available on the treatment of Elizabethkingia MDR VAP, but some studies suggest that fluoroquinolones may be effective in treating Elizabethkingia meningoseptica bacteremia 4.
- A study comparing the therapeutic efficacy of fluoroquinolone and non-fluoroquinolone treatment in patients with Elizabethkingia meningoseptica bacteremia found that the fluoroquinolone group had significantly lower 14-day mortality than the non-fluoroquinolone group 4.
- Another study suggests that vancomycin, alone or in combination with rifampicin, may be effective in treating Elizabethkingia meningoseptica meningitis 5.
- Guidelines for the management of hospital-acquired and ventilator-associated pneumonia caused by multidrug-resistant Gram-negative bacteria recommend adherence to international guidelines and consideration of local microbiological data and risk factors for MDR bacteria 6.
- The main risk factors for MDR Gram-negative pathogens include prior hospitalization for at least 5 days, prior use of broad-spectrum antibiotics, prior colonization with resistant pathogens, admission to hospital settings with high rates of MDR pathogens, and septic shock at the time of diagnosis with nosocomial pneumonia 6.