Epidemiological analysis of Elizabethkingia meningoseptica infection cluster among mechanically ventilated pediatric intensive care patients

Wafaa Seddik Hamza, Samar Saeed Morsi, Ebtehal Saleh Al Roomi, Vincent Olubunmi Rotimi


Background: Elizabethkingia meningoseptica is frequently found in hospital environments and usually associated with healthcare-associated infections (HAIs), particularly in patients in the intensive care units (ICU). The current study report an outbreak of E. meningoseptica infection/colonization in the pediatric intensive care unit, highlighted the infection control methods used to stem the spread.

Methods: During a period of 7 months, May-November 2015, 4 patients were infected/ colonized by E. meningoseptica. Infection control measures were re-emphasized after each case and environmental swabs were cultured to detect possible source. Follow up for 25 months to ensure eradication of the pathogen.

Results: Four patients were colonized/ infected with E. meningoseptica, their mean age 22 months. The average time patients spent in ICU between admission and isolation of E. meningoseptica was 27.5±19.2 days. All patients were mechanically ventilated. 25% E. meningoseptica isolated from blood causing healthcare associated Central Line Associated Blood Stream Infection (CLABSI) while it was isolated from endotracheal tube (ETT) secretion in 75% as healthcare associated colonization. The 4 isolates confirmed as identical using pulsed field gel electrophoresis (PFGE).

Conclusions: Intensive infection control measures including healthcare workers education, emphasizing hand hygiene, comprehensive cleaning and disinfection of equipment and the environment are important to eradicate the bacterium.


Elizabethkingia meningoseptica, Healthcare associated infections, Mechanical ventilation, Pediatric intensive care unit

Full Text:



King EO. Studies on a group of previously unclassified bacteria associated with meningitis in infants. Am J Clin Pathol. 1959;31:241-7.

Kim KK, Kim MK, Lim JH, Park HY, Lee ST. Transfer of Chryseobacterium meningosepticum and Chryseobacterium miricola to Elizabethkingia gen. nov. as Elizabethkingia meningoseptica comb. nov. and Elizabethkingia miricola comb. nov. Int J Syst Evol Microbiol. 2005;55:1287–93.

Center for Disease Control. Available at Assessed at 16 June 2016.

Bloch KC, Nadarajah R, Jacobs R. Chryseobacterium meningosepticum: an emerging pathogen among immunocompromised adults. Report of 6 cases and literature review. Medicine. 1997;76(1):30-41.

Ceyhan M, Yildirim I, Tekeli A, Yurdakok M, Us E, Altun B, et al., Chryseobacterium meningosepticum outbreak observed in 3 clusters involving both neonatal and non-neonatal pediatric patients. Am J Infect Control. 2008;36(6):453-7.

Hoque SN, Graham J, Kaufmann ME, Tabaqchali S. Chryseobacterium (Flavobacterium) meningo-septicum outbreak associated with colonization of water taps in a neonatal intensive care unit. J Hosp Infect. 2001;47:188-92.

Jean SS, Lee WS, Chen FL, Ou TY, Hsueh PR. Elizabethkingia meningoseptica: an important emerging pathogen causing healthcare-associated infections. J Hosp Infect. 2014;86(4):244-9.

Swain B, Rout S, Otta S, Rakshit A. Elizabethkingia meningoseptica: an unusual cause for septicaemia JMM Case Reports. 2014.

Lin YT, Chiu CH, Chan YJ, Lin ML, Yu KW, Wang FD, et al. Clinical and microbiological analysis of Elizabethkingia meningoseptica bacteremia in adult patients in Taiwan. Scand J Infect Dis. 2009;41:628-34.

Hsu MS, Liao CH, Huang YT, Liu CY, Yang CJ, Kao KL, et al. Clinical features, antimicrobial susceptibilities, and outcomes of Elizabethkingia meningoseptica (Chrseobacterium meningo-septicum) bacteremia at a medical center in Taiwan, 1999–2006. Eur J Clin Microbiol Infect Dis. 2011;10:1271–8.

Pereira Graziella H, de Oliveira GD, Saad AC, de Barros BVL, Lucas da SPS. Nosocomial infections caused by Elizabethkingia meningoseptica: an emergent pathogen. Braz J Infect Dis. 2013;17(5):606-9.

Güngör S, Ozen M, Akinci A, Durmaz R. A Chryseobacterium meningosepticum outbreak in a neonatal ward. Infect Control Hosp Epidemiol. 2003;24:613-7.

Steinberg JP, Burd EM. Other gram-negative and gram-variable bacilli. In Mandell GL, Bennett JE, Dolin R, editors. Principles and Practice of Infect Dis. Philadelphia: Churchill Livingstone Elsevier; 2010: 3015-3033.

Clinical and Laboratory Standards Institute (CLSI). Performance standards for antimicrobial susceptibility testing; 22nd International Supplement; Wayne, Pennsylvania. CLSI Document M100-S18. 2015.

Tenover FC, Arbeit RD, Goering RV, Mickelsen PA, Murray BE, Persing DH, et al. Interpreting chromosomal DNA restriction patterns produced by pulsed-field gel electrophoresis: Criteria for bacterial strain typing. J Clin Microbiol. 1995;33:2233-9.

Hung PP, Lin YH, Lin CF, Liu MF, Shi ZY. Chryseobacterium meningosepticum infection: antibiotic susceptibility and risk factors for mortality. J Microbiol Immunol Infect. 2008;41(2):137–44.

Weaver KN, Jones RC, Albright R, Thomas Y, Zambrano CH, Costello M, et al. Acute emergence of Elizabethkingia Meningoseptica infection among mechanically ventilated patients in a long-term acute care facility. Infect Control Hosp Epidemiol. 2010;31:54–8.

Jung SH, Lee B, Mirrakhimov AE, Hussain N. Septic shock caused by Elizabethkingia meningoseptica: a case report and review of literature. BMJ Case Reports. 2013: bcr2013009066.

Cabrera HA, Davis GH. Epidemic meningitis of the newborn caused by flavobacteria. I. Epidemiology and bacteriology. Am J Dis Child. 1961;201(3):289–95.

Ceyhan M, Celik M. Elizabethkingia meningosepticum (Chryseobacterium meningo-septicum) infections in Children. Int J Pediatr 2011;2011:215237.

Tak V, Mathur P, Varghese P, Misra MC. Elizabethkingia meningoseptica: An emerging pathogen causing meningitis in a hospitalized adult trauma patient. Indian J Med Microbiol. 2013;31:293-5.

Tekerekoglu MS, Durmaz R, Ayan M, Cizmeci Z, Akinci A. Analysis of an outbreak due to Chryseobacterium meningosepticum in a neonatal intensive care unit. New Microbiol. 2003;26:57-63.

Maraki S, Scoulica E, Manoura A, Papageorgiou N, Giannakopoulou C, Galanakis EA. Chryseobacterium meningosepticum colonization outbreak in a neonatal intensive care unit. Eur J Clin Microbiol Infect Dis. 2009;28:1415-9.

Johnston BL, Bryce E. Hospital infection control strategies for vancomycin-resistant Enterococcus, methicillin-resistant Staphylococcus aureus and Clostridium difficile. Can Med Assoc J. 2009;180:627-31.

Amer MZ, Bandey M, Bukhari A, Nemenqani D. Neonatal meningitis caused by Elizabethkingia Meningoseptica in Saudi Arabia. J Infect Dev Ctries. 2011;5:745–7.

Bhat KS, Priya R, Krishnan L, Kanungo R. Elizabethkingia meningoseptica bacteremia in a neonate: A case report and mini-review of the literature. J Curr Res Sci Med. 2016;2:42-5.

Chiu CH, Waddingdon M, Greenberg D, Schreckenberger PC, Carnahan AM. Atypical Chryseobacterium meningosepticum and meningitis and sepsis in newborns and the immune-compromised, Taiwan,” Emerging Infectious Diseases. 2000;6(5):481–6.

Hazuka BT, Dajani AS, Talbot K, Keen BM. Two outbreaks of Flavobacterium meningosepticum type E in a neonatal intensive care unit. J Clin Microbiol. 1977;6(5):450–5.