Elizabethkingia meningoseptica neonatal meningitis in a premature infant

Abstract

Premature infants are highly susceptible to infections especially highly resistant organisms which can be found in the hospital environment. Elizabethkingia meningoseptica is a gram-negative organism that has been associated with hospital-acquired outbreaks in neonates and immunocompromised patients, resulting in significant complications and high mortality. Difficulties in identification and inherent antimicrobial resistance further complicate patient management. Here we present a case of neonatal meningitis in a premature infant of dichorionic diamniotic (DCDA) twin, born at 33 weeks with a birth weight of 2.0 kg, who was initially admitted for transient tachypnoea of newborn. She required a non-invasive continuous pressure ventilation and after 10 days, was noted to be febrile, less active and developed seizures. Elizabethkingia meningoseptica was isolated from blood and CSF and identified by Vitek 2 system ® BioMerieux. The automated identification system has improved diagnostics in microbiology laboratories although many still encounter difficulties in the identification of non-fermenters gram negative organisms. The patient was successfully treated with IV vancomycin 30mg 8 hourly (15mg/kg/dose) and IV ciprofloxacin 20mg 8 hourly (10mg/kg/dose) for 6 weeks and oral rifampicin 20mg twice a day (10mg/kg/dose) was given for a total of 8 days according to susceptibility testing of the organism. However, her recovery was complicated with hydrocephalus which needed a ventriculoperitoneal shunt to be inserted. At follow up at 1 year, she was thriving but was diagnosed with bilateral hearing impairment. She also had multiple hospital admissions due to recurrent pneumonia. This case illustrates the significant morbidity associated with hospital-acquired infection of Elizabethkingia meningoseptica in this group of susceptible patients, and the importance of infection control practices in healthcare institutions.

Keywords: Elizabethkingia meningoseptica, neonatal meningitis, hospital-acquired infections, infection control