title: Waterborne Elizabethkingia meningoseptica in Adult Critical Care.
abstract: Elizabethkingia meningoseptica is an infrequent colonizer of the respiratory tract; its pathogenicity is uncertain. In the context of a 22-month outbreak of E. meningoseptica acquisition affecting 30 patients in a London, UK, critical care unit (3% attack rate) we derived a measure of attributable morbidity and determined whether E. meningoseptica is an emerging nosocomial pathogen. We found monomicrobial E. meningoseptica acquisition (n = 13) to have an attributable morbidity rate of 54% (systemic inflammatory response syndrome ≥2, rising C-reactive protein, new radiographic changes), suggesting that E. meningoseptica is a pathogen. Epidemiologic and molecular evidence showed acquisition was water-source-associated in critical care but identified numerous other E. meningoseptica strains, indicating more widespread distribution than previously considered. Analysis of changes in gram-negative speciation rates across a wider London hospital network suggests this outbreak, and possibly other recently reported outbreaks, might reflect improved diagnostics and that E. meningoseptica thus is a pseudo-emerging pathogen.
authors.forename: Luke S P
authors.initials: LS
authors.lastname: Moore
authors.forename: Daniel S
authors.initials: DS
authors.lastname: Owens
authors.forename: Annette
authors.initials: A
authors.lastname: Jepson
authors.forename: Jane F
authors.initials: JF
authors.lastname: Turton
authors.forename: Simon
authors.initials: S
authors.lastname: Ashworth
authors.forename: Hugo
authors.initials: H
authors.lastname: Donaldson
authors.forename: Alison H
authors.initials: AH
authors.lastname: Holmes
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D002097:C-Reactive Protein / Q000378:metabolism; D003422:Critical Care; D003428:Cross Infection / Q000188:drug therapy / Q000453:epidemiology* / Q000378:metabolism / Q000382:microbiology*; D004196:Disease Outbreaks; D005260:Female; D041965:Flavobacteriaceae / Q000187:drug effects / Q000302:isolation & purification*; D045826:Flavobacteriaceae Infections / Q000188:drug therapy / Q000453:epidemiology* / Q000378:metabolism / Q000382:microbiology; D006801:Humans; D015994:Incidence; D007362:Intensive Care Units; D008131:London / Q000453:epidemiology; D008297:Male; D008826:Microbial Sensitivity Tests / Q000379:methods; D008875:Middle Aged; D055815:Young Adult
chemical_list: D000900:Anti-Bacterial Agents; D002097:C-Reactive Protein
keywords: Chryseobacterium meningosepticum; Elizabethkingia meningoseptica; Flavobacterium meningosepticum; Matrix-assisted laser desorption/ionization time-of-flight; United Kingdom; adults; antimicrobial drug resistance; intensive care; water