Treatment of Elizabethkingia meningoseptica Neonatal Meningitis with Combination Systemic and Intraventricular Therapy
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Elizabethkingia meningoseptica, a gram negative bacillus ubiquitous in the hospital environment, is known to infrequently cause serious neonatal infections, particularly meningitis which is associated with high mortality and neuromorbidity in survivors. The authors describe a healthy term newborn with no apparent risk factors who developed Elizabethkingia meningoseptica sepsis and meningitis on day 6 of life. Diagnosis could be established only after a week of the illness by which time the baby developed refractory status epilepticus, ventriculitis and hydrocephalus. The isolate was susceptible to only ciprofloxacin, tigecycline and rifampicin and resistant to vancomycin. Apart from systemic combination therapy for 12 wk, intraventricular vancomycin was given through an external ventricular drain for 4 wk and later a ventriculo-peritoneal (VP) shunt was inserted. With this regime, authors demonstrated microbiologic and clinical cure. The baby is neurologically normal over a 6 mo follow-up.
KeywordsElizabethkingia Meningitis Intraventricular Vancomycin Neonate
The authors acknowledge help of Sweta Shah, Department of Microbiology for helping in identification and susceptibility testing and Pradnya Gadgil, Pediatric Neurologist.
PJ: Intensive care management and drafting of manuscript; BS: Clinical management, literature search and drafting of manuscript; VJ: Intensive care management and drafting of manuscript; AK: Neurosurgical management and drafting of manuscript; TS: Infectious disease opinion and reviewing the manuscript. TS will act as guarantor for this paper.
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