Silent Invader: One-year case series of Neonatal Elizabethkingia Septicemia

Background: Elizabethkingia species are non-fermenting, Gram-negative bacilli. They are emerging pathogens in hospital settings, primarily causing nosocomial infections in neonates. Material and Methods: A study was conducted in neonatal intensive care unit of Sri Avittam Thirunal Hospital, Thiruvananthapuram over a period of one year (October 2024 to September 2025). Blood samples from preterm neonates with suspected sepsis were collected in BACT/ALERT bottles sent to Microbiology laboratory for culture and sensitivity. Once positive signal was detected by the BACT/ALERT system, organism was grown in routine culture media and identified based on biochemical reactions. Antimicrobial susceptibility testing showed sensitivity to Vancomycin, a unique clue for identification. The species level identification was by MALDI-TOF and VITEK 2 system. Results: Elizabethkingia species was isolated from 11 preterm neonates (6 males, 5 females) suspected with late-onset septicemia. Common presenting features were poor activity, feeding intolerance and respiratory distress. Elizabethkingia meningoseptica and Elizabethkingia anophelis were the predominant species isolated. They showed resistance to β-lactams and aminoglycosides, with susceptibility to Fluoroquinolones, Cotrimoxazole, Minocycline and Vancomycin. Combination therapy with Cotrimoxazole, Ciprofloxacin and vancomycin led to clinical improvement in all cases except for one child, whose neurodevelopmental follow-up revealed hydrocephalus. During monthly environmental surveillance conducted in neonatal ICU, no Elizabethkingia species were isolated from any of the samples. Conclusion: Elizabethkingia species is an important emerging pathogen especially in late-onset neonatal sepsis with high resistance to conventional antibiotics. Early identification and appropriate antimicrobial therapy are crucial for favorable outcomes. The implementation of stringent infection control practices remains crucial to prevent neonatal septicemia caused by Elizabethkingia species.

Keywords: Elizabethkingia species, Neonatal septicemia, Non fermenting Gram-negative bacilli.