Elizabethkingia species as pathogens of acute bacterial lung destruction in immunosuppressed patients (case reports)

Background. Elizabethkingia spp. is still poorly explored pathogens with an intrinsic phenotype of multidrug resistance to several classes of antibiotics. In immunosuppressed and immunocompromised individuals, it causes acute bacterial destruction of the lung. Patients who have been taking antibiotics for a long time are more likely to develop nosocomial infections associated with the Elizabethkingia genus.

Case report. We report two cases of effective surgical treatment of bacterial lung destruction caused by Elizabethkingia species in immunosuppressed patients, and one of them also developed a nosocomial infection. Elizabethkingia spp. demonstrated polyresistance, which required a combination of antibacterial drugs and bacteriophage.

Conclusion. Bacteria of the genus Elizabethkingia belong to opportunistic human pathogens and can cause severe, mainly nosocomial infections in immunocompromised patients. The treatment presents a certain challenge due to their high natural resistance to most antimicrobial drugs traditionally used to manage infections caused by Gram-negative bacteria.

1. Beloborodov VB, Gusarov VG, Dekhnich AV, Zamyatin MN, Zubareva NA, Zyryanov SK, et al. Diagnostics and antimicrobial therapy of the infections caused by multiresistant microorganisms. Guidelines of the Association of Anesthesiologists-Intensivists, the Interregional Non-Governmental Organization Alliance of Clinical Chemotherapists and Microbiologists, the Interregional Association for Clinical Microbiology and Antimicrobial Chemotherapy, and NGO Russian Sepsis Forum. Messenger of Anesthesiology and Resuscitation. 2020; 17(1): 52-83. (In Russ.). doi: 10.21292/2078-5658-2020-17-1-52-83

2. Kanashenko ME, Kartsev NN, Mitsevich IP, Khramov МV, Svetoch EA. Elizabethkingia meningoseptica as a significant clinical pathogene. Bacteriology. 2019; 4(1): 58-63. (In Russ.). doi: 10.20953/2500-1027-2019-1-58-63

3. Lu TL, Huang C. Retrospective cohort study on Delftia acidovorans infections in patients: a rare and significant infection. Infect Drug Resist. 2024; 17: 1741–1749. doi: 10.2147/IDR.S457781

4. Gonzalez C, Coolen-Allou N, Allyn J, Estève JB, Belmonte O, Allou N. Sepsis grave lié à un abcès pulmonaire avec bactériémie à Elizabethkingia miricola [Severe sepsis and pulmonary abscess with bacteremia due to Elizabethkingia miricola]. Med Mal Infect. 2016; 46(1): 49–51. (In French). doi: 10.1016/j.medmal.2015.10.011

5. Qi PQ, Zeng YJ, Peng W, Kuai J. Lung imaging characteristics in a patient infected with Elizabethkingia miricola following cerebral hemorrhage surgery: a case report. World J Clin Cases. 2024; 12(1): 169-175. doi: 10.12998/wjcc.v12.i1.169

6. Chen S, Soehnlen M, Blom J, Terrapon N, Henrissat B, Walker ED. Comparative genomic analyses reveal diverse virulence factors and antimicrobial resistance mechanisms in clinical Elizabethkingia meningoseptica strains. PLoS One. 2019; 14(10): e0222648. doi: 10.1371/journal.pone.0222648

7. Burnard D, Gore L, Henderson A, Ranasinghe A, Bergh H, Cottrell K, et al. Comparative genomics and antimicrobial resistance profiling of Elizabethkingia isolates reveal nosocomial transmission and in vitro susceptibility to fluoroquinolones, tetracyclines, and trimethoprim–sulfamethoxazole. J Clin Microbiol. 2020; 58(9): e00730–20. doi: 10.1128/JCM.00730-20

8. Wang L, Zhang S, Li D, Hu F, Wang M, Guo C, et al. Molecular characteristics and antimicrobial sensitivity profiles of Elizabethkingia clinical isolates in Shanghai, China. Infect drug Resist. 2020; 13: 247–56. doi: 10.2147/IDR.S240963

9. Wu C, Xiong L, Liao Q, Zhang W, Xiao Y, Xie Y. Clinical manifestations, antimicrobial resistance and genomic feature analysis of multidrug–resistant Elizabethkingia strains. Ann Clin Microbiol Antimicrob. 2024; 23(1): 32. doi: 10.1186/s12941-024-00691-6

10. Chang TY, Chen HY, Chou YC, Cheng YH, Sun JR. In vitro activities of imipenem, vancomycin, and rifampicin against clinical Elizabethkingia species producing BlaB and GOB metallo–beta–lactamases. Eur J Clin Microbiol Infect Dis. 2019; 38(11): 2045–2052. doi: 10.1007/s10096019-03639-3

11. Højgaard SMM, Rezahosseini O, Knudsen JD, Fuglebjerg NJU, Skov M, Nielsen SD, et al. Characteristics and outcomes of patients with Delftia acidovorans infections: a retrospective cohort study. Microbiology Spectrum. 2022; 10(4): e0032622. doi: 10.1128/spectrum.00326-22

12. Das A, Kabi S, Kar D, Sahu KK. Prevalence of Elizabethkingia meningoseptica infections and their resistant pattern in tertiary care hospital. J Pure Appl Microbiol. 2022; 16(2): 967-973. doi: 10.22207/JPAM.16.2.19

13. Agha RA, Franchi T, Sohrabi C, Mathew G, Kerwan A; SCARE Group. The SCARE 2020 Guideline: Updating Consensus Surgical CAse REport (SCARE) Guidelines. Int J Surg. 2020; 84: 226-230. doi: 10.1016/j.ijsu.2020.10.034

14. Lin JN, Lai CH, Yang CH, Huang YH. Elizabethkingia infections in humans: from genomics to clinics. Microorganisms. 2019; 7(9): 295. doi: 10.3390/microorganisms7090295

15. Bilgin H, Sarmis A, Tigen E, Soyletir G, Mulazimoglu L. Delftia acidovorans: a rare pathogen in immunocompetent and immunocompromised patients. Can J Infect Dis Med Microbiol. 2015; 26(5): 277–279. doi: 10.1155/2015/973284