Community-Acquired Elizabethkingiameningoseptica with Leucine Aminopeptidase Activity as a Cause of Fatal Sepsis in an adult with Diabetes Mellitus - Abstract
Elizabethkingiameningoseptica is an oxidase- and catalase-positive nonfermentative environmental saprophytic Gram-negative rod that can colonize medical devices and equipment due to its ability to form bio films, thus, resisting mechanical and chemical disinfection. This organism is usually associated with multi-drug resistant nosocomial infections. Here, we present a case of community-acquired E. meningoseptica in a 73-year-old man with multiple co morbidities, who presented with symptoms, signs, and laboratory data consistent with sepsis and multi-organ dysfunction syndrome. Initial cultures from blood and pleural fluid grew E. meningoseptica. Automated antimicrobial susceptibility tests demonstrated resistance to numerous drugs, except for fluoroquinolones. The patient’s antibiotic regimen was switched from broad spectrum to levofloxacin with nafcillin on day five of hospital stay. Although the patient cleared E. meningoseptica infection, he remained in critical condition and shortly developed nosocomial infections involving the urinary tract with Candida albicans and the respiratory tract with Stenotrophomonas maltophilia that led to death. In patients who present with severe sepsis caused by non-fermenting Gram-negative bacillus, E. meningoseptica should be considered, noting its multi-drug resistance and the potential for a dismal outcome.