Mengwen Feng,1 Min Huang,2 Yuanyuan Fan,1 Genyan Liu,3 Suming Zhou,2 Jing Zhou2 

1Department of Critical Care Medicine, the First Affiliated Hospital of Nanjing Medical University, Nanjing, People’s Republic of China; 2Department of Geriatric Intensive Care Medicine, the First Affiliated Hospital of Nanjing Medical University, Nanjing, People’s Republic of China; 3Department of Laboratory Medicine, the First Affiliated Hospital of Nanjing Medical University, Nanjing, People’s Republic of China

Correspondence: Jing Zhou, Department of Geriatric Intensive Care Medicine, the First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Road, Nanjing, Jiangsu Province, 210029, People’s Republic of China, Email zhoujing1364@jsph.org.cn

Purpose: Elizabethkingia spp. infections have recently increased, and they are difficult to treat because of intrinsic antimicrobial resistance. This study aimed to investigate the clinical characteristics of patients with pulmonary infection with Elizabethkingia spp. and reveal the risk factors for infection and death.
Patients and Methods: In this retrospective case–control study, patients were divided into infection and control groups based on the bacterial identification results. Patients in the infection group were further divided into survival and death groups according to their hospital outcomes. Clinical characteristics between different groups were compared. We further analyzed antimicrobial susceptibility testing results of the isolated strains.
Results: A total of the 316 patients were divided into infection (n = 79), 23 of whom died, and control (n = 237) groups. Multivariate logistic regression analysis showed that glucocorticoid consumption (OR: 2.35; 95% CI: 1.14– 4.81; P = 0.02), endotracheal intubation (OR: 3.74; 95% CI: 1.62– 8.64; P = 0.002), and colistin exposure (OR: 2.50; 95% CI: 1.01– 6.29; P = 0.046) were significantly associated with pulmonary infection with Elizabethkingia spp. Advanced age (OR: 1.07, 95% CI: 1.00– 1.15; P = 0.046), high acute physiology and chronic health evaluation (APACHE) II score (OR: 1.21; 95% CI: 1.01– 1.45; P = 0.037), and low albumin level (OR: 0.73, 95% CI: 0.56– 0.96; P = 0.025) were significantly associated with in-hospital mortality of infected patients. Elizabethkingia spp. was highly resistant to cephalosporins, carbapenems, macrolides, and aminoglycoside, and was sensitive to fluoroquinolones, minocycline, and co-trimoxazole in vitro.
Conclusion: Glucocorticoid consumption, tracheal intubation, and colistin exposure were associated with pulmonary infection with Elizabethkingia spp. for critically ill patients. Patients with advanced age, high APACHE II score, and low albumin level had higher risk of death from infection.

Keywords: Elizabethkingia spp, intensive care unit, infection, mortality, antimicrobial susceptibility testing