Infection Control in the NICU: Addressing the Threat of Elizabethkingia meningoseptica and Multidrug-Resistant Organisms

Authors

  • Vidya Ravi Department of Microbiology, Armed Forces Medical College, Pune, India
  • Aditi Sondhi Department of Microbiology, Command Hospital Southern Command, Pune, India
  • Gurpreet Singh Bhalla Department of Microbiology, Command Hospital Southern Command, Pune, India
  • Nandita Hazra Department of Microbiology, Command Hospital Southern Command, Pune, India
  • G Shridhar Department of Paediatrics, Armed Forces Medical College, Pune, India
  • Amit Sood Department of Paediatrics, Command Hospital Western Command, Chandimandir, India
  • Leo Praveen Kumar Department of Microbiology, Armed Forces Medical College, Pune, India

DOI:

https://doi.org/10.21276/apalm.3678

Keywords:

elizabethkingia meningoseptica, NICU, environmental surveillance

Abstract

Background: Elizabethkingia meningoseptica is an opportunistic, intrinsically multidrug-resistant gram-negative bacillus increasingly implicated in neonatal intensive care unit (NICU) outbreaks.

Methods: This retrospective case series with environmental surveillance describes two NICU outbreaks (September 2023 and February – March 2024) involving four neonates in a tertiary care hospital. Environmental samples were collected from various sites within the NICU on two occasions following the outbreaks. Cultures and antimicrobial susceptibility testing (AST) were done as per standard protocols to isolate the pathogen and to report its AST profile.

Results: Elizabethkingia meningoseptica was isolated from blood and cerebrospinal fluid of affected neonates and from NICU water-associated sites confirming its role in the outbreaks. Targeted infection control interventions resulted in complete containment of the outbreak.

Conclusion: This study documents a NICU outbreak of Elizabethkingia meningoseptica linked to environmental water sources. Early environmental surveillance and prompt multidisciplinary infection control interventions successfully terminated the outbreak. Sustained environmental surveillance of NICU is essential to prevent recurrence.

References

1. King EO. Studies on a group of previously unclassified bacteria associated with meningitis in infants. Am J Clin Pathol. 1959. Available from: http://ajcp.oxfordjournals.org

2. Kottapalli P, Deepika C, Jyothi S, Mol R, Sadhana YV, Chander Reddy PN. Outbreak investigation of Elizabethkingia meningoseptica at a tertiary care hospital. J Patient Saf Infect Control. 2021;9(3):77–82.

3. Goel S, Jhajra SD, Nangia S, Kumar A, Nanda D. Neonatal meningitis secondary to Elizabethkingia meningoseptica infection. J Glob Infect Dis. 2023;15(1):23–7.

4. Barnawi AI, Kordy FN, Almuwallad OK, Kassarah KA. Early neonatal sepsis and meningitis caused by Elizabethkingia meningoseptica in Saudi Arabia. Saudi Med J. 2020;41(7):753–6.

5. Sahu MK, Balasubramaniam U, Bipin C, Singh SP, Talwar S. Elizabethkingia meningoseptica: An emerging nosocomial pathogen causing septicemia in critically ill patients. Indian J Crit Care Med. 2019;23(2):104–5.

6. Ma S, Gong Y, Luo X, Peng Y, Zhang C, Zhang X, et al. Emerging prevalence and clinical features of Elizabethkingia meningoseptica infection in Southwest China: A 9-year retrospective study and systematic review. Infect Drug Resist. 2023;16:531–43.

7. Erinmez M, Büyüktas Manay A, Zer Y. Investigation of an outbreak of Elizabethkingia meningoseptica on a pediatric intensive care unit. GMS Hyg Infect Control. 2021 May 31;16:Doc19. doi: 10.3205/dgkh000390. PMID: 34113537; PMCID: PMC8167457

8. Singh S, Sahu C, Singh Patel S, Ghoshal U. Clinical profile, susceptibility patterns, speciation and follow-up of infections by Elizabethkingia species: Study on a rare nosocomial pathogen from an intensive care unit of North India. New Microbes New Infect. 2020;38:100798.

9. Nazeer I, Alaraj JM, Parvez Y. Elizabethkingia meningoseptica: A rare cause of infection in neonates. Asian J Pediatr Res. 2024;14(9):23–31.

10. Zajmi A, Teo J, Yeo CC. Epidemiology and characteristics of Elizabethkingia spp. infections in Southeast Asia. Microorganisms. 2022;10(5):1001.

11. Govindaswamy A, Bajpai V, Trikha V, Mittal S, Malhotra R, Mathur P. Multidrug-resistant Elizabethkingia meningoseptica bacteremia: Experience from a level 1 trauma centre in India. Intractable Rare Dis Res. 2018;7(3):172–6.

12. Tai IC, Liu TP, Chen YJ, Lien RI, Lee CY, Huang YC. Outbreak of Elizabethkingia meningoseptica sepsis with meningitis in a well-baby nursery. J Hosp Infect. 2017;96(2):168–71.

13. Umair A, Nasir N. Clinical features and outcomes of critically ill patients with Elizabethkingia meningoseptica: An emerging pathogen. Acute Crit Care. 2021;36(3):256–61.

14. Jaggi N, Singh V. Successful control of Elizabethkingia meningoseptica outbreak in a neurosurgical intensive care unit of a tertiary care center in India. Int J Infect Control. 2018;14(2). Available from: www.ijic.info

15. Moore LSP, Owens DS, Jepson A, Turton JF, Ashworth S, Donaldson H, et al. Waterborne Elizabethkingia meningoseptica in adult critical care. Emerg Infect Dis. 2016;22(1):9–17.

16. Joshi P, Shah B, Joshi V, Kumar A, Singhal T. Treatment of Elizabethkingia meningoseptica neonatal meningitis with combination systemic and intraventricular therapy. Indian J Pediatr. 2019;86(4):379–81.

17. Chan JC, Chong CY, Thoon KC, Tee NWS, Maiwald M, Lam JCM, et al. Invasive paediatric Elizabethkingia meningoseptica infections are best treated with a combination of piperacillin/tazobactam and trimethoprim/sulfamethoxazole or fluoroquinolone. J Med Microbiol. 2019;68(8):1167–72.

18. Mallinckrodt L, Huis in 't Veld R, Rosema S, Voss A, Bathoorn E. Review on infection control strategies to minimize outbreaks of the emerging pathogen Elizabethkingia anophelis. Antimicrob Resist Infect Control. 2023;12(1):1–10.

19. Comba IY, Schuetz AN, Misra A, Friedman DZP, Stevens R, Patel R, et al. Antimicrobial susceptibility of Elizabethkingia species: Report from a reference laboratory. J Clin Microbiol. 2022;60(6):e0025622.

20. Chiu CT, Lai CH, Huang YH, Yang CH, Lin JN. Comparative analysis of gradient diffusion and disk diffusion with agar dilution for susceptibility testing of Elizabethkingia anophelis. Antibiotics (Basel). 2021;10(4):450.

21. Bennett JE, Dolin R, Blaser MJ. Mandell, Douglas, and Bennett's principles and practice of infectious diseases. 9th ed. Philadelphia: Elsevier; 2020.

22. Yung CF, Maiwald M, Loo LH, Soong HY, Tan CB, Lim PK, et al. Elizabethkingia anophelis and association with tap water and handwashing, Singapore. Emerg Infect Dis. 2018;24(9):1730–3.

Downloads

Published

06-04-2026

Issue

Section

Original Article

How to Cite

1.
Infection Control in the NICU: Addressing the Threat of Elizabethkingia meningoseptica and Multidrug-Resistant Organisms. Ann of Pathol and Lab Med [Internet]. 2026 Apr. 6 [cited 2026 Apr. 8];13(4):A172-A177. Available from: https://pacificejournals.com/journal/index.php/apalm/article/view/3678