Risk factors for mortality in Elizabethkingia spp. bloodstream infections
Abstract
BACKGROUND: Elizabethkingia spp. are uniquely challenging nosocomial pathogens to manage. Clinical breakpoints are not defined for trimethoprim-sulfamethoxazole (TMP-SMX), levofloxacin or piperacillin-tazobactam. We describe the clinical, laboratory and microbiological parameters that are associated with increased mortality in patients with Elizabethkingia spp. bacteraemia.
METHODS: We retrospectively examined consecutive patients with Elizabethkingia spp. bacteraemia from 2012 to 2024, comparing those who experienced in-hospital mortality and those who survived. Additionally, in the subgroups of patients receiving piperacillin-tazobactam, levofloxacin or TMP-SMX for therapy, we investigated if the antimicrobial susceptibility testing minimum inhibitory concentrations (MICs) correlated with adverse outcomes.
RESULTS: We identified 127 distinct episodes of Elizabethkingia spp. bacteraemia. In-hospital mortality was 29.9% (n = 38). Prolonged duration of fever, elevated C-reactive protein, total white cell count and lactate dehydrogenase levels were associated with mortality. Most patients who survived received a duration of antibiotics 2 weeks or longer (84.3% vs. 21.6%, P < 0.001). On multivariable analyses, a prolonged duration of fever and elevated C-reactive protein remained independently associated with mortality, after adjusting for age, Pitt bacteraemia score, antibiotic regimen and interventions for source control such as line removal. No specific antimicrobial regimen…
How strong is the evidence?
Evidence Hub reads this as a cohort study, done in people. Its evidence level is 3 of 5 (Moderate · trial / cohort / secondary analysis). Trials without a large randomized design, cohorts and secondary analyses give moderate evidence. Reported size: 38 participants or records.
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