A Case Series of Elizabethkingia \u3cem\u3emeningosepticum\u3c/em\u3e Bacteremia in the Cancer Population

Background :Elizabethkingia meningosepticum (E. meningosepticum) is a ubiquitous microorganism previously known as Chryseobacterium meningosepticum. It is emerging as a pathogen responsible for bacteremia in immunocompromised patients such as cancer patients especially those with a history of prolonged hospital stay and frequent instrumentations. Methods: A retrospective chart review of all cases over 10 years in Moffitt Cancer Center showed a total of three patients with E. meningosepticum infection. Results: First patient (history of multiple myeloma) underwent endoscopy complicated by aspiration pneumonia and blood culture positive for E. meningosepticum infection. He was treated with ciprofloxacin, cefoxitin, minocycline and metronidazole and was discharged in stable conditions after 10 days. The second patient (current acute myelogenous leukemia) had neutropenic fever in the setting of recent chest port infection. Blood culture from chest port showed E. meningosepticum and was treated with ciprofloxacin, meropenem and minocycline successfully. The third patient (history of esophageal adenocarcinoma and acute myelogenous leukemia) had history of recent pneumonia and cellulitis who came in with recurrent neutropenic fever. Blood culture was positive for E. meningosepticum and was treated with ciprofloxacin and minocycline. However, the infection was complicated by multiorgan failure and required tracheostomy. As these three cases illustrate, E. meningosepticum bacteremia has high 28- day mortality rate (41%). Conclusion: Early identification of the pathogen along with empiric treatment with a fluoroquinolone and/or minocycline is indicated to reduce morbidity and mortality