title: Elizabethkingia anophelis bacteremia is associated with clinically significant infections and high mortality.
abstract: Unlike Elizabethkingia meningoseptica, the clinical importance of E. anophelis is poorly understood. We determined the clinical and molecular epidemiology of bacteremia caused by Elizabethkingia-like species from five regional hospitals in Hong Kong. Among 45 episodes of Elizabethkingia-like bacteremia, 21 were caused by Elizabethkingia, including 17 E. anophelis, three E. meningoseptica and one E. miricola; while 24 were caused by other diverse genera/species, as determined by 16S rRNA gene sequencing. Of the 17 cases of E. anophelis bacteremia, 15 (88%) were clinically significant. The most common diagnosis was pneumonia (n = 5), followed by catheter-related bacteremia (n = 4), neonatal meningitis (n = 3), nosocomial bacteremia (n = 2) and neutropenic fever (n = 1). E. anophelis bacteremia was commonly associated with complications and carried 23.5% mortality. In contrast, of the 24 episodes of bacteremia due to non-Elizabethkingia species, 16 (67%) were clinically insignificant. Compared to non-Elizabethkingia bacteremia, Elizabethkingia bacteremia was associated with more clinically significant infections (P < 0.01) and positive cultures from other sites (P < 0.01), less polymicrobial bacteremia (P < 0.01), and higher complication (P < 0.05) and mortality (P < 0.05) rates. Elizabethkingia bacteremia is predominantly caused by E. anophelis instead of E. meningoseptica. Elizabethkingia bacteremia, especially due to E. anophelis, carries significant morbidity and mortality, and should be considered clinically significant unless proven otherwise.
authors.affiliation: Department of Microbiology, The University of Hong Kong, Hong Kong, China.|State Key Laboratory of Emerging Infectious Diseases, The University of Hong Kong, Hong Kong, China.|Research Centre of Infection and Immunology, The University of Hong Kong, Hong Kong, China.|Carol Yu Centre for Infection, The University of Hong Kong, Hong Kong, China.
authors.forename: Susanna K P
authors.initials: SK
authors.lastname: Lau
authors.affiliation: Department of Microbiology, The University of Hong Kong, Hong Kong, China.
authors.forename: Wang-Ngai
authors.initials: WN
authors.lastname: Chow
authors.affiliation: Department of Microbiology, The University of Hong Kong, Hong Kong, China.
authors.forename: Chuen-Hing
authors.initials: CH
authors.lastname: Foo
authors.affiliation: Department of Microbiology, The University of Hong Kong, Hong Kong, China.
authors.forename: Shirly O T
authors.initials: SO
authors.lastname: Curreem
authors.affiliation: Department of Microbiology, The University of Hong Kong, Hong Kong, China.
authors.forename: George Chi-Shing
authors.initials: GC
authors.lastname: Lo
authors.affiliation: Department of Microbiology, The University of Hong Kong, Hong Kong, China.
authors.forename: Jade L L
authors.initials: JL
authors.lastname: Teng
authors.affiliation: Department of Microbiology, The University of Hong Kong, Hong Kong, China.
authors.forename: Jonathan H K
authors.initials: JH
authors.lastname: Chen
authors.affiliation: Department of Pathology, United Christian Hospital, Hong Kong, China.
authors.forename: Ricky H Y
authors.initials: RH
authors.lastname: Ng
authors.affiliation: Department of Pathology, Pamela Youde Nethersole Eastern Hospital, Hong Kong, China.
authors.forename: Alan K L
authors.initials: AK
authors.lastname: Wu
authors.affiliation: Department of Pathology, Kwong Wah Hospital, Hong Kong, China.
authors.forename: Ingrid Y Y
authors.initials: IY
authors.lastname: Cheung
authors.affiliation: Department of Pathology, United Christian Hospital, Hong Kong, China.
authors.forename: Sandy K Y
authors.initials: SK
authors.lastname: Chau
authors.affiliation: Department of Clinical Pathology, Tuen Mun Hospital, Hong Kong, China.
authors.forename: David C
authors.initials: DC
authors.lastname: Lung
authors.affiliation: Department of Pathology, Pamela Youde Nethersole Eastern Hospital, Hong Kong, China.
authors.forename: Rodney A
authors.initials: RA
authors.lastname: Lee
authors.affiliation: Department of Pathology, Kwong Wah Hospital, Hong Kong, China.
authors.forename: Cindy W S
authors.initials: CW
authors.lastname: Tse
authors.affiliation: Department of Pathology, United Christian Hospital, Hong Kong, China.
authors.forename: Kitty S C
authors.initials: KS
authors.lastname: Fung
authors.affiliation: Department of Clinical Pathology, Tuen Mun Hospital, Hong Kong, China.
authors.forename: Tak-Lun
authors.initials: TL
authors.lastname: Que
authors.affiliation: Department of Microbiology, The University of Hong Kong, Hong Kong, China.|State Key Laboratory of Emerging Infectious Diseases, The University of Hong Kong, Hong Kong, China.|Research Centre of Infection and Immunology, The University of Hong Kong, Hong Kong, China.|Carol Yu Centre for Infection, The University of Hong Kong, Hong Kong, China.
authors.forename: Patrick C Y
authors.initials: PC
authors.lastname: Woo
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016470:Bacteremia / Q000453:epidemiology* / Q000382:microbiology / Q000401:mortality / Q000473:pathology*; D002648:Child; D002675:Child, Preschool; D045247:Chryseobacterium / Q000145:classification / Q000235:genetics / Q000302:isolation & purification*; D016000:Cluster Analysis; D004269:DNA, Bacterial / Q000737:chemistry / Q000235:genetics; D004275:DNA, Ribosomal / Q000737:chemistry / Q000235:genetics; D005260:Female; D045826:Flavobacteriaceae Infections / Q000453:epidemiology* / Q000382:microbiology / Q000401:mortality / Q000473:pathology*; D006723:Hong Kong / Q000453:epidemiology; D006761:Hospitals; D006801:Humans; D007223:Infant; D008297:Male; D008875:Middle Aged; D017720:Molecular Epidemiology; D012336:RNA, Ribosomal, 16S / Q000235:genetics; D017422:Sequence Analysis, DNA; D019032:Spectrometry, Mass, Matrix-Assisted Laser Desorption-Ionization; D016019:Survival Analysis; D055815:Young Adult
chemical_list: D004269:DNA, Bacterial; D004275:DNA, Ribosomal; D012336:RNA, Ribosomal, 16S