Elizabethkingia meningoseptica in a Ventilator-Dependent Pediatric Patient: Distinguishing Colonization from Infection and the Importance of Targeted Therapy

Öz

In this case report, we present the clinical significance and treatment response of Elizabethkingia meningoseptica isolated from an endotracheal aspirate culture in a three-year-old ventilator-dependent male patient with multiple comorbidities, including cerebral palsy and prune belly syndrome, who was followed for a prolonged period in the pediatric intensive care unit. The pathogen was identified using the VITEK-2 automated system; despite multidrug resistance on antimicrobial susceptibility testing, it was found to be susceptible to trimethoprim/sulfamethoxazole (TMP/SMX). Due to persistent fever, increased tracheal secretions, and lack of improvement in oxygen requirement under colistin therapy, colistin was discontinued and TMP/SMX treatment was initiated according to the susceptibility result. Marked clinical improvement was observed within 48–72 hours after initiation of TMP/SMX. The isolated organism was considered to represent a clinically significant infection based on clinical deterioration, concurrent radiological and laboratory findings, absence of an alternative pathogen explaining the infection, and clinical response to TMP/SMX within 48–72 hours. This case highlights that E. meningoseptica should be considered in the differential diagnosis of pediatric intensive care patients with prolonged hospitalization who do not respond to empirical therapy, and emphasizes the importance of distinguishing colonization from infection and initiating appropriate targeted antimicrobial therapy.

Anahtar Kelimeler

• Elizabethkingia meningoseptica
• multidrug resistance
• pediatric intensive care unit
• ventilator-associated pneumonia

Destekleyen Kurum

yok

Etik Beyan

This study was designed as a retrospective single case report. During hospitalization, general informed consent was obtained from the patient’s legal guardian for the use of anonymized medical data for scientific and academic purposes. No identifying information or images of the patient were included in the report.

Ventilatör Bağımlı Pediatrik Hastada Elizabethkingia meningoseptica: Kolonizasyon-Enfeksiyon Ayrımı ve Hedefe Yönelik Tedavinin Önemi

Öz

Bu olgu sunumunda, serebral palsi ve prune belly sendromu dâhil çoklu komorbiditeleri bulunan, uzun süre çocuk yoğun bakım ünitesinde izlenen ve mekanik ventilatör bağımlı üç yaşındaki erkek hastada, endotrakeal aspirat kültüründe izole edilen Elizabethkingia meningoseptica’nın klinik önemi ve tedaviye yanıtı sunulmaktadır. Etken, VITEK-2 otomatize sistemi ile tanımlanmış; antibiyogramda çoklu ilaç direnci saptanmasına karşın trimetoprim/sülfametoksazole duyarlılık belirlenmiştir. Kolistin tedavisi altında klinik yanıt alınamayan hastada trimetoprim/sülfametoksazol tedavisinin başlanmasını takiben ilk 48–72 saat içerisinde belirgin klinik düzelme gözlenmiştir. İzole edilen etkenin klinik olarak enfeksiyon etkeni olduğu; klinik kötüleşme, eş zamanlı radyolojik ve laboratuvar bulgular, enfeksiyonu açıklayabilecek alternatif bir patojen saptanmaması ve TMP/SMX tedavisine 48–72 saat içinde alınan klinik yanıt birlikte değerlendirilerek düşünülmüştür. Bu olgu, yoğun bakımda uzun süre izlenen ve ampirik tedaviye yanıt vermeyen pediatrik hastalarda E. meningoseptica’nın ayırıcı tanıda mutlaka düşünülmesi gerektiğini ve uygun antimikrobiyal tedavi seçiminin önemini vurgulamaktadır.

Anahtar Kelimeler

• Elizabethkingia meningoseptica
• çoklu antibiyotik direnci
• pediatrik yoğun bakım
• ventilatör ilişkili pnömoni

Destekleyen Kurum

yok

Etik Beyan

Bu çalışma retrospektif nitelikte tek olgu sunumu şeklinde hazırlanmıştır. Hastaneye yatış sırasında hastanın yasal vasisinden, tıbbi verilerin anonimleştirilerek bilimsel ve akademik amaçlarla kullanılabileceğine dair genel bilgilendirilmiş onam alınmıştır. Olguda kimlik belirleyici herhangi bir bilgi veya görsel kullanılmamıştır.

Kaynakça

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