title: Risk factors and outcome of levofloxacin-resistant Elizabethkingia meningoseptica bacteraemia in adult patients in Taiwan.
abstract: Elizabethkingia meningoseptica is an emerging nosocomial pathogen associated with high mortality and inherently resistant to many antimicrobial agents. Levofloxacin has been considered as a therapeutic agent based on in vitro susceptibility. We aim to investigate the risk factors and outcomes for levofloxacin-resistant E. meningoseptica bacteraemia. Adult patients with E. meningoseptica bacteraemia were identified retrospectively in a medical centre in Taiwan from January 2011 to July 2015. These strains were identified by the Vitek2 automated system or matrix-assisted laser desorption-ionization time-of-flight mass spectrometry. We compared clinical features and outcomes of patients with levofloxacin-resistant (MIC >2 μg/mL) and levofloxacin-susceptible (MIC ≤2 μg/mL) E. meningoseptica bacteraemia. A total of 93 patients were identified, including 51 (54.8%) with levofloxacin-resistant E. meningoseptica bacteraemia. The APACHE II score (OR, 1.08; 95% CI, 1.02-1.14; p = 0.008) was the only independent risk factor for levofloxacin-resistant E. meningoseptica bacteraemia. The 14-day mortality for patients with levofloxacin-resistant E. meningoseptica bacteraemia (attributable mortality: 30.7%) was significantly higher than that for patients with the levofloxacin-susceptible strain (56.9% versus 26.2%, p = 0.003). In the multivariate analysis of risk factors for mortality, appropriate definite antibiotic use was the only factor associated with 14-day survival (OR, 0.11; 95% CI, 0.02-0.55, p = 0.007). The levofloxacin-resistant strain was borderline significantly associated with mortality (OR, 3.09; 95% CI, 0.88-10.91, p = 0.079). The early identification of levofloxacin resistance in E. meningoseptica isolates is important to tackle this multi-drug resistance pathogen.
authors.affiliation: Division of Infectious Diseases, Department of Medicine, Taipei Veterans General Hospital, No. 201, Sec. 2, Shih-Pay Road, Taipei, 112, Taiwan.
authors.forename: Y-C
authors.initials: YC
authors.lastname: Huang
authors.affiliation: Department of Biotechnology and Laboratory Science in Medicine, National Yang-Ming University, Taipei, Taiwan.
authors.forename: Y-W
authors.initials: YW
authors.lastname: Huang
authors.affiliation: Division of Infectious Diseases, Department of Medicine, Taipei Veterans General Hospital, No. 201, Sec. 2, Shih-Pay Road, Taipei, 112, Taiwan. ytlin8@vghtpe.gov.tw.|Institute of Emergency and Critical Care Medicine, National Yang-Ming University, Taipei, Taiwan. ytlin8@vghtpe.gov.tw.
authors.forename: Y-T
authors.identifier: http://orcid.org/0000-0003-4466-8486
authors.initials: YT
authors.lastname: Lin
authors.affiliation: Division of Infectious Diseases, Department of Medicine, Taipei Veterans General Hospital, No. 201, Sec. 2, Shih-Pay Road, Taipei, 112, Taiwan.|School of Medicine, National Yang-Ming University, Taipei, Taiwan.
authors.forename: F-D
authors.initials: FD
authors.lastname: Wang
authors.affiliation: School of Medicine, National Yang-Ming University, Taipei, Taiwan.|Division of Microbiology, Department of Pathology and Laboratory Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.
authors.forename: Y-J
authors.initials: YJ
authors.lastname: Chan
authors.affiliation: Department of Biotechnology and Laboratory Science in Medicine, National Yang-Ming University, Taipei, Taiwan.
authors.forename: T-C
authors.initials: TC
authors.lastname: Yang
mesh_terms: D018806:APACHE; D000046:Academic Medical Centers; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000494:pharmacology*; D016470:Bacteremia / Q000188:drug therapy / Q000453:epidemiology* / Q000401:mortality / Q000473:pathology; D045247:Chryseobacterium / Q000187:drug effects* / Q000302:isolation & purification*; D024881:Drug Resistance, Bacterial; D005260:Female; D045826:Flavobacteriaceae Infections / Q000188:drug therapy / Q000453:epidemiology* / Q000401:mortality / Q000473:pathology; D006801:Humans; D064704:Levofloxacin / Q000494:pharmacology*; D008297:Male; D008826:Microbial Sensitivity Tests; D008875:Middle Aged; D012189:Retrospective Studies; D012307:Risk Factors; D019032:Spectrometry, Mass, Matrix-Assisted Laser Desorption-Ionization; D016019:Survival Analysis; D013624:Taiwan / Q000453:epidemiology; D016896:Treatment Outcome
chemical_list: D000900:Anti-Bacterial Agents; D064704:Levofloxacin