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Waterborne Elizabethkingia meningoseptica in Adult Critical Care.

Moore LS, Owens DS, Jepson A, Turton JF, Ashworth S, Donaldson H, Holmes AH - Emerging Infect. Dis. (2016)

Bottom Line: Elizabethkingia meningoseptica is an infrequent colonizer of the respiratory tract; its pathogenicity is uncertain.In the context of a 22-month outbreak of E. meningoseptica acquisition affecting 30 patients in a London, UK, critical care unit (3% attack rate) we derived a measure of attributable morbidity and determined whether E. meningoseptica is an emerging nosocomial pathogen.Epidemiologic and molecular evidence showed acquisition was water-source-associated in critical care but identified numerous other E. meningoseptica strains, indicating more widespread distribution than previously considered.

View Article: PubMed Central - PubMed

ABSTRACT
Elizabethkingia meningoseptica is an infrequent colonizer of the respiratory tract; its pathogenicity is uncertain. In the context of a 22-month outbreak of E. meningoseptica acquisition affecting 30 patients in a London, UK, critical care unit (3% attack rate) we derived a measure of attributable morbidity and determined whether E. meningoseptica is an emerging nosocomial pathogen. We found monomicrobial E. meningoseptica acquisition (n = 13) to have an attributable morbidity rate of 54% (systemic inflammatory response syndrome ≥2, rising C-reactive protein, new radiographic changes), suggesting that E. meningoseptica is a pathogen. Epidemiologic and molecular evidence showed acquisition was water-source-associated in critical care but identified numerous other E. meningoseptica strains, indicating more widespread distribution than previously considered. Analysis of changes in gram-negative speciation rates across a wider London hospital network suggests this outbreak, and possibly other recently reported outbreaks, might reflect improved diagnostics and that E. meningoseptica thus is a pseudo-emerging pathogen.

No MeSH data available.


Related in: MedlinePlus

Clinicophysiologic parameters of patients with monomicrobial acquisition of Elizabethkingia meningoseptica in an outbreak in an adult critical care unit, London, UK, 2012–2013. Thirteen patients in the outbreak cohort were identified as having monomicrobial E. meningoseptica acquisition. Of these, 8 patients demonstrated an increase in 5 clinicophysiologic parameters of inflammation during the 48 hours before and after acquisition of E. meningoseptica: A) body temperature; B) oxygen saturation; C) pulse rate; D) lymphocyte count; and D) C-reactive protein. Patient numbers match those given in Table 1.
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Figure 2: Clinicophysiologic parameters of patients with monomicrobial acquisition of Elizabethkingia meningoseptica in an outbreak in an adult critical care unit, London, UK, 2012–2013. Thirteen patients in the outbreak cohort were identified as having monomicrobial E. meningoseptica acquisition. Of these, 8 patients demonstrated an increase in 5 clinicophysiologic parameters of inflammation during the 48 hours before and after acquisition of E. meningoseptica: A) body temperature; B) oxygen saturation; C) pulse rate; D) lymphocyte count; and D) C-reactive protein. Patient numbers match those given in Table 1.

Mentions: Eleven of the 30 case-patients received antimicrobial drug therapy targeted at E. meningoseptica, in all cases for a clinical diagnosis of hospital-acquired pneumonia. Thirteen patients were identified within the outbreak cohort in whom no discernible microbiological evidence of other pathogens was found in the 7 days before or after E. meningoseptica acquisition (Figure 2). In the 48 hours before and after E. meningoseptica acquisition, in terms of SIRS response, 7 case-patients had new-onset fever, 7 had new tachycardia, and 8 had new leukocyte count change. Additionally, 4 had increasing oxygen requirements, 7 had new increase in CRP, and 8 had new infiltrates on chest radiography. Moreover, targeted E. meningoseptica antimicrobial therapy was begun on 8 of these patients by the physicians coordinating care. Therefore, attributable illness (SIRS >2) from acquisition of E. meningoseptica in this outbreak was 54%.


Waterborne Elizabethkingia meningoseptica in Adult Critical Care.

Moore LS, Owens DS, Jepson A, Turton JF, Ashworth S, Donaldson H, Holmes AH - Emerging Infect. Dis. (2016)

Clinicophysiologic parameters of patients with monomicrobial acquisition of Elizabethkingia meningoseptica in an outbreak in an adult critical care unit, London, UK, 2012–2013. Thirteen patients in the outbreak cohort were identified as having monomicrobial E. meningoseptica acquisition. Of these, 8 patients demonstrated an increase in 5 clinicophysiologic parameters of inflammation during the 48 hours before and after acquisition of E. meningoseptica: A) body temperature; B) oxygen saturation; C) pulse rate; D) lymphocyte count; and D) C-reactive protein. Patient numbers match those given in Table 1.
© Copyright Policy
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC4696684&req=5

Figure 2: Clinicophysiologic parameters of patients with monomicrobial acquisition of Elizabethkingia meningoseptica in an outbreak in an adult critical care unit, London, UK, 2012–2013. Thirteen patients in the outbreak cohort were identified as having monomicrobial E. meningoseptica acquisition. Of these, 8 patients demonstrated an increase in 5 clinicophysiologic parameters of inflammation during the 48 hours before and after acquisition of E. meningoseptica: A) body temperature; B) oxygen saturation; C) pulse rate; D) lymphocyte count; and D) C-reactive protein. Patient numbers match those given in Table 1.
Mentions: Eleven of the 30 case-patients received antimicrobial drug therapy targeted at E. meningoseptica, in all cases for a clinical diagnosis of hospital-acquired pneumonia. Thirteen patients were identified within the outbreak cohort in whom no discernible microbiological evidence of other pathogens was found in the 7 days before or after E. meningoseptica acquisition (Figure 2). In the 48 hours before and after E. meningoseptica acquisition, in terms of SIRS response, 7 case-patients had new-onset fever, 7 had new tachycardia, and 8 had new leukocyte count change. Additionally, 4 had increasing oxygen requirements, 7 had new increase in CRP, and 8 had new infiltrates on chest radiography. Moreover, targeted E. meningoseptica antimicrobial therapy was begun on 8 of these patients by the physicians coordinating care. Therefore, attributable illness (SIRS >2) from acquisition of E. meningoseptica in this outbreak was 54%.

Bottom Line: Elizabethkingia meningoseptica is an infrequent colonizer of the respiratory tract; its pathogenicity is uncertain.In the context of a 22-month outbreak of E. meningoseptica acquisition affecting 30 patients in a London, UK, critical care unit (3% attack rate) we derived a measure of attributable morbidity and determined whether E. meningoseptica is an emerging nosocomial pathogen.Epidemiologic and molecular evidence showed acquisition was water-source-associated in critical care but identified numerous other E. meningoseptica strains, indicating more widespread distribution than previously considered.

View Article: PubMed Central - PubMed

ABSTRACT
Elizabethkingia meningoseptica is an infrequent colonizer of the respiratory tract; its pathogenicity is uncertain. In the context of a 22-month outbreak of E. meningoseptica acquisition affecting 30 patients in a London, UK, critical care unit (3% attack rate) we derived a measure of attributable morbidity and determined whether E. meningoseptica is an emerging nosocomial pathogen. We found monomicrobial E. meningoseptica acquisition (n = 13) to have an attributable morbidity rate of 54% (systemic inflammatory response syndrome ≥2, rising C-reactive protein, new radiographic changes), suggesting that E. meningoseptica is a pathogen. Epidemiologic and molecular evidence showed acquisition was water-source-associated in critical care but identified numerous other E. meningoseptica strains, indicating more widespread distribution than previously considered. Analysis of changes in gram-negative speciation rates across a wider London hospital network suggests this outbreak, and possibly other recently reported outbreaks, might reflect improved diagnostics and that E. meningoseptica thus is a pseudo-emerging pathogen.

No MeSH data available.


Related in: MedlinePlus