Skip to main content Skip to main navigation menu Skip to site footer

Meningitis dan bakteremia pada bayi prematur yang disebabkan oleh Elizabethkingia meningoseptica di RSUP Sanglah : Laporan kasus pertama yang dipublikasi

Abstract

Introduction: Elizabethkingia meningoseptica (E. meningoseptica) is a non-fermentative gram-negative bacillus that is commonly found in aquatic environments, including adequately chlorinated water reservoirs. E. meningoseptica very rarely causes infection in humans, but is often associated with neonatal meningitis and bacteremia, especially in premature neonates or newborns weighing less than 2,500 g. Infections that occur are often severe and life-threatening or can be cured but with sequelae. The characteristics of E. meningoseptica are its resistance to some antibiotics commonly used for gram-negative bacterial infections, but its susceptibility to antibiotics commonly used for gram-positive bacterial infections; Thus, conventional empiric antibiotics often lead to unfavorable outcomes. Special understanding is needed for clinicians of E. meningoseptica infection to prevent errors in management.

Case report: We report a case of meningitis and sepsis caused by E. meningoseptica in a female preterm infant born at 33 weeks gestation, in which the onset of fever occurred on day 19 of life. The infant received empiric therapy with intravenous ampicillin and amikacin. E. meningoseptica was identified from 2-sided cerebrospinal fluid and blood culture specimens, 3 days after collection. Infants then received definitive antibiotic therapy of intravenous ciprofloxacin for 25 days (4 weeks). The baby's clinical condition showed improvement, which was marked by normalization of cerebrospinal fluid although with hydrocephalus sequelae, and finally the baby was allowed to go home.

Conclusion: Prompt and precise diagnosis in clinical samples and sensitivity testing, appropriate empiric antibiotic therapy, and long-term definitive therapy are key factors in the successful management of E. meningoseptica infection.

 

Pendahuluan: Elizabethkingia meningoseptica (E. meningoseptica) adalah bakteri basil gram-negatif non- fermentatif yang banyak ditemukan di lingkungan air, termasuk penampungan air yang terklorinasi secara adekuat. E. meningoseptica sangat jarang menyebabkan infeksi pada manusia, namun sering dikaitkan dengan meningitis neonatus dan bakteremia, terutama pada neonatus prematur atau bayi baru lahir dengan berat badan kurang dari 2.500 gr. Infeksi yang terjadi seringkali berat dan mengancam jiwa atau dapat sembuh namun dengan sekuele. Karakteristik dari E. meningoseptica adalah resistensinya terhadap beberapa antibiotik yang biasa digunakan untuk infeksi bakteri gram-negatif, namun rentan terhadap antibiotik yang biasa digunakan untuk infeksi bakteri gram-positif; sehingga pemberian antibiotik empiris konvensional sering menyebabkan hasil yang tidak menguntungkan. Perlu pemahaman khusus bagi para klinisi terhadap infeksi E. meningoseptica untuk mencegah kesalahan dalam penatalaksanaan.

Laporan kasus: Kami melaporkan kasus meningitis dan sepsis yang disebabkan oleh E. meningoseptica pada bayi prematur perempuan yang lahir pada usia kehamilan 33 minggu, dimana onset demam terajdi pada hari ke 19 kehidupan. Bayi mendapatkan terapi empiris ampisilin dan amikasin intravena. E. meningoseptica teridentifikasi dari spesimen kultur cairan serebrospinal dan darah 2 sisi, 3 hari setelah dikoleksi. Bayi kemudian mendapatkan terapi antibiotik definitif siprofloksasin intravena selama 25 hari (4 minggu). Kondisi klinis bayi menunjukkan perbaikan, yang ditandai dengan normalisasi cairan serebrospinal meskipun dengan sekuele hidrosefalus, dan akhirnya bayi diijinkan pulang ke rumah.

Simpulan: Diagnosis yang cepat dan tepat dalam sampel klinis dan pengujian sensitivitas, pemberian terapi antibiotik empiris yang tepat, serta pemberian terapi definitif untuk jangka waktu yang lama merupakan faktor kunci dalam keberhasilan pengelolaan infeksi E. meningoseptica.

References

  1. Kim, K. K., Kim, M. K., Lim, J. H., Park, H. Y. & Lee, S. T. Transfer of Chryseobacterium meningosepticum and Chryseobacterium miricola to Elizabethkingia gen. nov. as Elizabethkingia meningoseptica comb. nov. and Elizabethkingia miricola comb. nov. Int. J. Syst. Evol. Microbiol. 55, 1287–1293 (2005).
  2. Güngör, S., Özen, M., Akinci, A. & Durmaz, R. A Chryseobacterium Meningosepticum Outbreak in a Neonatal Ward. Infect. Control Hosp. Epidemiol. 24, 613–617 (2003).
  3. Jean, S. S., Lee, W. S., Chen, F. L., Ou, T. Y. & Hsueh, P. R. Elizabethkingia meningoseptica: An important emerging pathogen causing healthcare-associated infections. J. Hosp. Infect. 86, 244–249 (2014).
  4. King, E. 0. Studies on A Group of Previously Unclassified Bacteria Associated With Meningitis In Infants Elizabeth. Am. J. Clin. Pathol. 31, 241–247 (1959).
  5. Bhat, Ks., Priya, R., Krishnan, L. & Kanungo, R. Elizabethkingia meningoseptica bacteremia in a neonate: A case report and mini-review of the literature. J. Curr. Res. Sci. Med. 2, 42 (2016).
  6. Oren, A. et al. Proposal to include the rank of phylum in the international code of nomenclature of prokaryotes. Int. J. Syst. Evol. Microbiol. 65, 4284–4287 (2015).
  7. Sarma, S., Kumar, N., Jha, A., Baveja, U. & Sharma, S. Elizabethkingia meningosepticum: An Emerging Cause of Septicemia in Critically Ill Patients. J. Lab. Physicians 3, 061–062 (2011).
  8. Bloch, K. C., Nadarajah, R. & Jacobs, R. Chryseobacterium meningosepticum: An emerging pathogen among immunocompromised adults. Medicine vol. 76 30–41 (1997).
  9. Ratnamani, M. & Rao, R. Elizabethkingia meningoseptica : Emerging nosocomial pathogen in bedside hemodialysis patients. Indian J. Crit. Care Med. 17, 304–307 (2013).
  10. Tai, I. C. et al. Outbreak of Elizabethkingia meningoseptica sepsis with meningitis in a well-baby nursery. J. Hosp. Infect. 96, 168–171 (2017).
  11. Dziuban, E. J., Franks, J. L., So, M., Peacock, G. & Blaney, D. D. Elizabethkingia in children: A comprehensive review of symptomatic cases reported from 1944 to 2017. Clin. Infect. Dis. 67, 144–149 (2018).
  12. Hsu, M. S. et al. Clinical features, antimicrobial susceptibilities, and outcomes of Elizabethkingia meningoseptica (Chryseobacterium meningosepticum) bacteremia at a medical center in Taiwan, 1999-2006. Eur. J. Clin. Microbiol. Infect. Dis. 30, 1271–1278 (2011).
  13. Bruun, B., Jensen, E. T., Lundstrøm, K. & Andersen, G. E. Flavobacterium meningosepticum infection in a neonatal ward. Eur. J. Clin. Microbiol. Infect. Dis. 8, 509–514 (1989).
  14. Ceyhan, M. et al. A Chryseobacterium meningosepticum outbreak observed in 3 clusters involving both neonatal and non-neonatal pediatric patients. Am. J. Infect. Control 36, 453–457 (2008).
  15. Huang, Y. C., Lin, Y. T. & Wang, F. Der. Comparison of the therapeutic efficacy of fluoroquinolone and non-fluoroquinolone treatment in patients with Elizabethkingia meningoseptica bacteraemia. Int. J. Antimicrob. Agents 51, 47–51 (2018).
  16. Kirby, J. T., Sader, H. S., Walsh, T. R. & Jones, R. N. Antimicrobial Susceptibility and Epidemiology of a Worldwide Collection of Chryseobacterium spp.: Report from the SENTRY Antimicrobial Surveillance Program (1997-2001). J. Clin. Microbiol. 42, 445– 448 (2004).
  17. Ceyhan, M. & Celik, M. Elizabethkingia meningosepticum ( Chryseobacterium meningosepticum ) Infections in Children . Int. J. Pediatr. 2011, 1–7 (2011).
  18. Jacobs, A. & Chenia, H. Y. Biofilm formation and adherence characteristics of an Elizabethkingia meningoseptica isolate from Oreochromis mossambicus. Ann. Clin. Microbiol. Antimicrob. 10, 16 (2011).
  19. Hoque, S. N., Graham, J., Kaufmann, M. E. & Tabaqchali, S. Chryseobacterium (Flavobacterium) meningosepticum outbreak associated with colonization of water taps in a neonatal intensive care unit. J. Hosp. Infect. 47, 188–192 (2001).
  20. Amer, M. Z., Bandey, M., Bukhari, A. & Nemenqani, D. Neonatal meningitis caused by Elizabethkingia meningoseptica in Saudi Arabia. J. Infect. Dev. Ctries. 5, 745–747 (2011).
  21. Issack, M. I. & Neetoo, Y. An outbreak of Elizabethkingia meningoseptica neonatal meningitis in mauritius. J. Infect. Dev. Ctries. 5, 834–839 (2011).
  22. van de Beek, D. et al. ESCMID guideline: Diagnosis and treatment of acute bacterial meningitis. Clin. Microbiol. Infect. 22, S37–S62 (2016).
  23. Bernardet, J.-F., Hugo, C. & Bruun, B. The Genera Chryseobacterium and Elizabethkingia. The Prokaryotes (2006). doi:10.1007/0-387-30747-8_25.
  24. Lin, P. Y. et al. Clinical and microbiological analysis of bloodstream infections caused by Chryseobacterium meningosepticum in nonneonatal patients. J. Clin. Microbiol. 42, 3353–3355 (2004).
  25. Di Pentima, M. C., Mason, E. O. & Kaplan, S. L. In vitro antibiotic synergy against Flavobacterium meningosepticum. Clin. Infect. Dis. 25, 421 (1997).
  26. Shah, Z., Soodhana, D., Kalathia, M. & Parikh, Y. Elizabethkingia meningoseptica: an emerging threat. Int. J. Contemp. Pediatr. 4, 1909 (2017).
  27. Rossolini, G. M. et al. Cloning of a Chryseobacterium (Flavobacterium) meningosepticum chromosomal gene (blaA(CME)) encoding an extended-spectrum class a β- lactamase related to the Bacteroides cephalosporinases and the VEB-1 and PER β-lactamases. Antimicrob. Agents Chemother. 43, 2193–2199 (1999).
  28. Woodford, N., Palepou, M. F. I., Babini, G. S., Holmes, B. & Livermore, D. M.
  29. Carbapenemases of Chryseobacterium (Flavobacterium) meningosepticum: Distribution of blaB and characterization of a novel metallo-β-lactamase gene, blaB3, in the type strain, NCTC 10016. Antimicrob. Agents Chemother. 44, 1448–1452 (2000).
  30. Moore, L. S. P. et al. Waterborne in Adult Critical Care. Emerg. Infect. Dis. 22, 9–17 (2016).
  31. Shinha, T. & Ahuja, R. Bacteremia due to Elizabethkingia meningoseptica. IDCases 2, 13–15 (2015).
  32. Boroda, K. & Li, L. Elizabethkingia meningosepticum in a Patient with Six-Year Bilateral Perma-Catheters . Case Rep. Infect. Dis. 2014, 1–3 (2014).
  33. Owens, R. C. & Ambrose, P. G. Clinical use of the fluoroquinolones. Med. Clin. North Am. 84, 1447–1469 (2000).
  34. Forsythe, C. T. & Ernst, M. E. Do fluoroquinolones commonly cause arthropathy in children? Can. J. Emerg. Med. 9, 459–462 (2007).
  35. Adefurin, A., Sammons, H., Jacqz-Aigrain, E. & Choonara, I. Ciprofloxacin safety in paediatrics: A systematic review. Arch. Dis. Child. 96, 874–880 (2011).
  36. Kaguelidou, F., Turner, M. A., Choonara, I. & Jacqz-Aigrain, E. Ciprofloxacin use in neonates: A systematic review of the literature. Pediatr. Infect. Dis. J. 30, 29–37 (2011).
  37. Vasiliki Drossou-Agakidou et al. Use of ciprofloxacin in neonatal sepsis: lack of adverse effects up to one year. Pediatr Infect Dis J 23, 346–349 (2004).
  38. Vincent, J. L. et al. Advances in antibiotic therapy in the critically ill. Crit. Care 20, 1–13 (2016).
  39. Neuner, E. A. et al. Use of therapeutic drug monitoring to treat Elizabethkingia meningoseptica meningitis and bacteraemia in an adult. J. Antimicrob. Chemother. 67, 1558–1560 (2012).
  40. Blot, S. I., Pea, F. & Lipman, J. The effect of pathophysiology on pharmacokinetics in the critically ill patient - Concepts appraised by the example of antimicrobial agents. Adv. Drug Deliv. Rev. 77, 3–11 (2014).
  41. Hazuka, B. T., Dajani, A. S., Talbot, K. & Keen, B. M. Two outbreaks of Flavobacterium meningosepticum type E in a neonatal intensive care unit. J. Clin. Microbiol. 6, 450–455 (1977).
  42. Levitz, R. E. & Quintiliani, R. Trimethoprim-sulfamethoxazole for bacterial meningitis.
  43. Ann. Intern. Med. 100, 881–890 (1984).
  44. Hand, E., Davis, H., Kim, T. & Duhon, B. Monotherapy with minocycline or trimethoprim/sulfamethoxazole for treatment of Stenotrophomonas maltophilia infections.
  45. J. Antimicrob. Chemother. 71, 1071–1075 (2016).
  46. Samonis, G. et al. Stenotrophomonas maltophilia infections in a general hospital: Patient characteristics, antimicrobial susceptibility, and treatment outcome. PLoS One 7, (2012).
  47. Cho, S. Y. et al. Can levofloxacin be a useful alternative to trimethoprim- Sulfamethoxazole for treating stenotrophomonas maltophilia bacteremia? Antimicrob. Agents Chemother. 58, 581–583 (2014).
  48. Gokce, I. K. et al. Trimethoprim-sulfamethoxazole treatment for meningitis owing to multidrug-resistant Elizabethkingia meningoseptica in an extremely low-birthweight, premature infant. Paediatr. Int. Child Health 32, 177–179 (2012).
  49. Yoon, H. S. Case report-Two cases of Chryseobacterium meningosepticum infection in a neonatal intensive care unit. Korean J. Pediatr. 50, 698–701 (2007).
  50. Tunkel, A. R. et al. Practice guidelines for the management of bacterial meningitis. Clin. Infect. Dis. 39, 1267–1284 (2004).
  51. Brouwer, M. C., Tunkel, A. R. & Van De Beek, D. Epidemiology, diagnosis, and antimicrobial treatment of acute bacterial meningitis. Clin. Microbiol. Rev. 23, 467–492 (2010).
  52. Dahesihdewi A, Sugianli AK, Parwati I. The surveillance of antibiotics resistance in Indonesia: a current reports. Bali Medical Journal. 2019 Aug 1;8(2):565-70.

How to Cite

Panggabean, J., Darwinata, A. E., & Tarini, N. M. A. (2023). Meningitis dan bakteremia pada bayi prematur yang disebabkan oleh Elizabethkingia meningoseptica di RSUP Sanglah : Laporan kasus pertama yang dipublikasi. Medicina, 54(2), 38–44. https://doi.org/10.15562/medicina.v54i2.1194

HTML
362

Total
101

Share

Search Panel