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Risk factors and outcome of levofloxacin-resistant Elizabethkingia meningoseptica bacteraemia in adult patients in Taiwan

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Abstract

Elizabethkingia meningoseptica is an emerging nosocomial pathogen associated with high mortality and inherently resistant to many antimicrobial agents. Levofloxacin has been considered as a therapeutic agent based on in vitro susceptibility. We aim to investigate the risk factors and outcomes for levofloxacin-resistant E. meningoseptica bacteraemia. Adult patients with E. meningoseptica bacteraemia were identified retrospectively in a medical centre in Taiwan from January 2011 to July 2015. These strains were identified by the Vitek2 automated system or matrix-assisted laser desorption-ionization time-of-flight mass spectrometry. We compared clinical features and outcomes of patients with levofloxacin-resistant (MIC >2 μg/mL) and levofloxacin-susceptible (MIC ≤2 μg/mL) E. meningoseptica bacteraemia. A total of 93 patients were identified, including 51 (54.8%) with levofloxacin-resistant E. meningoseptica bacteraemia. The APACHE II score (OR, 1.08; 95% CI, 1.02–1.14; p = 0.008) was the only independent risk factor for levofloxacin-resistant E. meningoseptica bacteraemia. The 14-day mortality for patients with levofloxacin-resistant E. meningoseptica bacteraemia (attributable mortality: 30.7%) was significantly higher than that for patients with the levofloxacin-susceptible strain (56.9% versus 26.2%, p = 0.003). In the multivariate analysis of risk factors for mortality, appropriate definite antibiotic use was the only factor associated with 14-day survival (OR, 0.11; 95% CI, 0.02–0.55, p = 0.007). The levofloxacin-resistant strain was borderline significantly associated with mortality (OR, 3.09; 95% CI, 0.88–10.91, p = 0.079). The early identification of levofloxacin resistance in E. meningoseptica isolates is important to tackle this multi-drug resistance pathogen.

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Acknowledgments

The authors thank Ms. Chiu-Mei Yeh for her endorsement and assistance in the statistical analyses. We also thank the Medical Science and Technology Building of Taipei Veterans General Hospital for providing experimental space and facilities. Some results from this study were presented as a paper poster at the ASM Microbe 2016 in Boston, Massachusetts, United States.

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Authors and Affiliations

  1. Division of Infectious Diseases, Department of Medicine, Taipei Veterans General Hospital, No. 201, Sec. 2, Shih-Pay Road, Taipei, 112, Taiwan

    Y.-C. Huang, Y.-T. Lin & F.-D. Wang

  2. Department of Biotechnology and Laboratory Science in Medicine, National Yang-Ming University, Taipei, Taiwan

    Y.-W. Huang & T.-C. Yang

  3. Institute of Emergency and Critical Care Medicine, National Yang-Ming University, Taipei, Taiwan

    Y.-T. Lin

  4. School of Medicine, National Yang-Ming University, Taipei, Taiwan

    F.-D. Wang & Y.-J. Chan

  5. Division of Microbiology, Department of Pathology and Laboratory Medicine, Taipei Veterans General Hospital, Taipei, Taiwan

    Y.-J. Chan

Authors
  1. Y.-C. Huang
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  2. Y.-W. Huang
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  3. Y.-T. Lin
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  4. F.-D. Wang
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  5. Y.-J. Chan
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  6. T.-C. Yang
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Corresponding author

Correspondence to Y.-T. Lin.

Ethics declarations

Isolates were obtained as part of the routine activity and were analysed anonymously in a retrospective manner.

Funding

This study was partly supported by grants from the Ministry of Science and Technology in Taiwan, Taipei Veterans General Hospital (V105B-001 and V106B-001) and Szu-Yuan Research Foundation of Internal Medicine.

Conflict of interests

The authors declare that they have no competing interests.

Ethics approval and informed consent

The study was approved by the Institution Review Board of Taipei Veterans General Hospital. The written informed consent form was waived.

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Huang, YC., Huang, YW., Lin, YT. et al. Risk factors and outcome of levofloxacin-resistant Elizabethkingia meningoseptica bacteraemia in adult patients in Taiwan. Eur J Clin Microbiol Infect Dis 36, 1373–1380 (2017). https://doi.org/10.1007/s10096-017-2942-7

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  • DOI: https://doi.org/10.1007/s10096-017-2942-7

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