Elizabethkingia anophelis: Experience of an Academic Health System in Southeastern Wisconsin

Background: Starting late 2015 an increased number of infections due to Elizabethkingia spp. were identified in Southeastern Wisconsin with a high mortality rate. We aim to describe our experience as the only academic health system in the Southeastern Wisconsin region.

Methods: Consecutive patients identified from November 2015 until April 2016 at an academic health system comprised of three hospitals (1 urban and 2 community based). The microbiology records were prospectively searched and the medical records of identified cases were summarized.

Results: During the six months of surveillance, a total of 12 patients were identified with cultures growing Elizabethkingia. 10 were identified upon admission to our system and 2 were positive at transferring facilities prior to admission to our system. 10 were further identified to be E.anophelis. 2 of the 10 cases originally identified by our laboratory tested positive for Elizabethkingia, but were not confirmed as the same strain of E.anophelis because the specimens were not available for further testing. Out of the 10 patients identified initially at our system, 50% were female and the mean age was 70.8 years (range: 56-84). 10 out of the 12 patients had positive blood cultures on admission. One patient had positive blood, pleural fluid, and sputum cultures; and one patient had positive blood and synovial fluid cultures. Patients were admitted to our system with a myriad of presentations, including hyperglycemia, hypoglycemia, Klebsiella spp. urinary tract infection, respiratory failure, cellulitis, and change in mental status. Most patients were transferred from home although all had healthcare exposures within the past 6 months. Comorbidites included cancer (n=2), COPD(n=3), diabetes (n=4), hemodialysis, and alcoholism. Three patients died during the 6-month surveillance period (mortality rate: 25%). Two died during the admission when Elizabethkingia was identified, and one died 4.5 months after isolation.

Conclusion: A total of 10 patients were identified in our health system with cultures positive for E.anophelis, with 2 additional probable cases testing positive for Elizabethkingia. All patients had positive blood cultures at the time of hospital admission, and all had major comorbidities with recent healthcare exposure. Mortality rate was high.