A Prospective Study on Clinical Characteristics, Antibiotic Susceptibility Patterns, and Factors Predicting Mortality Associated with E. Meningoseptica Infections in Critically Ill Patients Admitted to A Tertiary Care Hospital in Eastern India

Abstract

Background: Elizabethkingiameningoseptica is an emerging multidrug-resistant pathogen associated with high mortality in critically ill patients. Data on clinical characteristics, antibiotic susceptibility, and outcomes in the Indian ICU setting is limited.

Methods: This prospective study was conducted in the medical ICU of a IMS & SUM tertiary care hospital in Eastern India from May 2019 to August 2022. Critically ill patients with E. meningoseptica isolated from sterile specimens were included. Demographic details, comorbidities, microbiological data, treatment details, and outcome were noted.

Results: Of 3700 ICU admissions, 35 patients developed E. meningoseptica infection. Mean age was 60.2 years and 63% were males. Majority had pneumonia (71%) or urosepsis (14%). Key comorbidities were hypertension (49%), diabetes (43%), chronic kidney disease (40%), and chronic dialysis (23%). All isolates were sensitive to Minocycline while 43% were sensitive to Levofloxacin and ciprofloxacin each. Empiric minocycline-levofloxacin combination was used in 49% patients. Crude mortality was 54%. Mortality was significantly associated with higher severity scores, coronary artery disease, acute/chronic kidney injury, respiratory co-infection, and prolonged ICU stay. Mortality was found to be lower in case of Minocycline and Levofloxacin combination therapy (35%) compared to Minocycline and Levofloxacin monotherapy (75%).

Conclusion: E. meningoseptica caused high mortality in critically ill patients despite treatment. There is increasing incidence of resistance to fluroquinolones among the E. meingoseptica isolates found in the ICU and all were susceptible to Minocycline. Combination regimens with Minocycline may be studied in future randomized trials to study the efficacy in treating E. meningoseptica infections.  Infection control and antimicrobial stewardship are keys to prevent further resistance.