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Chryseobacterium Related Genera Infections☆
Chryseobacterium Related Genera Infections☆ SJ Booth, Nebraska Medical Center, Omaha, NE, USA ã 2014 Elsevier Inc. All rights reserved.
Introduction Definition Classification Consequences Associated Disorders Epidemiology Pathophysiology Signs and Symptoms Standard Therapies Experimental Therapies Animal Models References
1 1 1 2 2 2 2 2 2 3 3 3
Introduction Chryseobacterium and related genera consist of bacteria previously classified in the genus Flavobacterium (Vandamme et al., 1994), (Vaneechoutte et al., 2011). All are gram-negative aerobic nonfermenting bacilli. The genus Flavobacterium, as it is currently defined, contains no pathogenic species. The former flavobacteria-like organisms that are potential human pathogens include those currently classified in the genera Chryseobacterium, Elizabethkingia, Myroides, Empedobacter, and Sphingobacterium. These are rare opportunistic pathogens of low virulence that may occasionally be involved in severe infections. Within this group, Elizabethkingia meningoseptica, formerly Chryseobacterium meningosepticum is the most common and important pathogen, particularly in neonatal meningitis. Infection is typically from an environmental source.
Definition Chryseobacterium and related bacteria are gram-negative nonfermenters that are oxidase positive and usually produce indole from tryptophan. Many produce pigmented colonies, typically various shades of yellow. There are approximately 80 species of Chryseobacterium, most of which are non-pathogenic environmental isolates, usually associated with moist environments. Chryseobacterium indologenes and Chryseobacterium gleum are human pathogens and are former members of the genus Flavobacterium (Vandamme et al., 1994), (Winn et al., 2006). C. meningosepticum, a rare but serious cause of neonatal meningitis, has been reclassified as Elizabethkingia meningoseptica (Kim et al., 2005). It is the most significant of the pathogens within this group Fisher (2014). Flavobacterium odoratum has been placed into the genus Myroides as two species, M. odoratus and M. odoratimimus (Vancanneyt et al., 1996). Unlike Chryseobacterium, Myroides are indole negative (Winn et al., 2006). They are rare isolates from human infections. Flavobacterium brevis has been reclassified as Empedobacter brevis (Vandamme et al., 1994). It is the only species in this genus and rarely a human pathogen. The two most commonly isolated species of Sphingobacterium from human infections are S. multivorum and S. spiritivorum, both of which are indole negative (Winn et al., 2006).
Classification The genus Flavobacterium has undergone extensive taxonomic revision (Vandamme et al., 1994), (Vancanneyt et al., 1996), (Vaneechoutte et al., 2011). The genus, as it was originally defined, consisted of phenotypically similar nonfermenting gramnegative bacteria that were oxidase positive and produced a yellow pigment. Analyses of rRNA, as well as other characteristics such as G + C content and DNA homology, made it clear that reclassification, as outlined above, was warranted. A list of recent taxonomic changes for Chryseobacterium, Elizabethkingia, Myroides, Empedobacter, and Sphingobacterium with links to 16S rRNA gene sequences can be found at http://www.bacterio.net/.
☆
Change History: August 2014. SJ Booth updated the text and added new references to the entire article.
Reference Module in Biomedical Research
http://dx.doi.org/10.1016/B978-0-12-801238-3.04922-9
1
2
Chryseobacterium Related Genera Infections
Consequences Infections with Chryseobacterium, Elizabethkingia, Myroides, Empedobacter, and Sphingobacterium are relatively rare, affecting primarily neonates or immunocompromised patients. Infections vary and include intraabdominal, wound, endocarditis, pneumonia, septicemia, and can be associated with indwelling devices such as catheters. (Bloch, Nadarajah, and Jacobs 1997) found that within the genus Chryseobacterium, C. meningosepticum (now Elizabethkingia meningoseptica) is the most common pathogen. In a review of the literature over a 10-year period, they found that 59% of 308 cultures positive for C. meningosepticum (E. meningoseptica) were associated with true infections (i.e. the isolated bacteria were not contaminants or passive colonizers). Of these infections, 65% were in infants less than three months of age and presented as meningitis (84% in neonates). The mortality rate in neonatal meningitis was high (57%). Bacteremia and pneumonia due to E. meningoseptica have been reported in neonates. Adult infections have several presentations, including pneumonia, septicemia, meningitis, endocarditis, postsurgical, postburn, etc. Although infections are usually in immunosuppressed individuals, (Gunnarsson et al., 2002) reported a case of septic arthritis due to C. meningosepticum (E. meningoseptica) in an immunocompetent patient. Empedobacter brevis is a rare nosocomial pathogen that is occasionally a cause of meningitis. Although it has been isolated from other clinical specimens such as blood and urine, its role in infections is unclear (Bellais et al., 2002b). Sphingobacterium infections, most of which are nosocomial (peritonitis, bacteremia, respiratory, etc.) are also relatively rare. S. multivorum was recently isolated from a patient with necrotizing fasciitis (Grimaldi et al., 2012).
Associated Disorders Myroides odoratus and M. odoratimimus are associated with various opportunistic infections, including cellulitis, bacteremia, and urinary tract infections (Green et al., 2001), (Mammeri et al., 2002), and (Maraki et al., 2012).
Epidemiology The genera Chryseobacterium, Elizabethkingia, Myroides, Empedobacter, and Sphingobacterium are primarily of environmental origin (soil, plants, water, food, etc.) and have been isolated from moist areas within hospitals. Some strains can survive in chlorinated municipal water supplies, giving them a selective advantage in hospital water systems (Winn et al., 2006), (Kirby et al., 2004). As a result of C. meningosepticum being reclassified as E. meningoseptica, C. indologenes is now the most common clinical isolate within the genus Chryseobacterium (Kirby et al., 2004), Fisher (2014).
Pathophysiology All of these organisms are of relatively low virulence. Specific virulence factors for most are not known. E. meningoseptica isolates may have a capsule that is potentially antiphagocytic, and they can produce proteases and a gelatinase that could be involved in tissue damage (Forbes et al., 2007). The specific role of these factors in the infectious process is unknown.
Signs and Symptoms There are no unique signs and symptoms of disease with any of these organisms. Diagnosis is based on isolation and identification of the specific organism.
Standard Therapies Species of Chryseobacterium, Elizabethkingia, Myroides, Empedobacter, and Sphingobacterium are intrinsically resistant to a wide range of antibiotics. Most produce beta-lactamases and are often resistant to aminoglycosides, tetracyclines, chloramphenicol, erythromycin, clindamycin, and teicoplanin (Kirby et al., 2004), (Vessillier et al., 2002), (Bellais et al., 2002a), (Bellais et al., 2002b), (Mammeri et al., 2002), (Vandamme et al., 1994), (Blahova et al., 1997), (Winn et al., 2006). Metallo-b-lactamases (MBL) have been described in E. meningoseptica Gonza´lez and Vila (2012). E. meningoseptica is unique in that it is the only known organism containing two chromosome-borne MBL genes (Bellais et al., 2000). An extended-spectrum b-lactamase (ESBL) was recently described for C. indologenes (Matsumoto et al., 2012). IND-type metallo-b-lactamases have also been described for this organism (Perilli et al., 2007). Myroides are usually resistant to the b-lactams, aminoglycosides, aztreonam and carbapenems (Winn et al., 2006), (Maraki et al., 2012). Empedobacter brevis infections are rare, but susceptibility patterns seem to parallel Chryseobacterium and Myroides. E. brevis has been shown to produce an Ambler subclass B1 b-lactamase (Bellais et al., 2002b). As a consequence of the
Chryseobacterium Related Genera Infections
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rarity of Sphingobacterium infections, there are no established therapies. Sphingobacterium species are generally susceptible to the fluoroquinolones and trimethoprim/sulfamethoxazole (Winn et al., 2006). A recent isolate of S. multivorum in a case of necrotizing fasciitis was susceptible to amoxicillin-clavulanate, ticarcillin-clavulanate, fluoroquinolones, and trimethoprim/sulfamethoxazole (Grimaldi et al., 2012). Due to the variability in susceptibility patterns, and the discrepancies for therapeutic drugs in the literature, susceptibility testing should be performed on each isolate of any of the organisms discussed. Although there are no validated susceptibility testing methods (Forbes et al., 2007), a broth microdilution method was recommended by Fraser and Jorgensen (1997) and was used by (Kirby et al., 2004) for determining the minimal inhibitory concentrations (MIC’s) for approximately 20 strains each of C. meningosepticum (E. meningoseptica) and C. indologenes. The Etest may be useful for determining the MIC’s for some antibiotics (Winn et al., 2006).
Agent Name
Discussion
Fluoroquinolones
The fluoroquinolones are generally effective against Chryseobacterium, Elizabethkingia, Sphingobacterium, and Myroides (Winn et al., 2006), (Maraki et al., 2012). A case of septic arthritis due to E. meningoseptica was effectively treated with intravenous ciprofloxacin and vancomycin, followed after hospital discharge with oral ciprofloxacin (Gunnarsson et al., 2002). Resistance of E. meningoseptica to ciprofloxacin has been reported (Hoque et al., 2001). E. meningoseptica and C. indologenes are generally susceptible to garenoxacin, gatifloxacin, and levofloxacin (Kirby et al., 2004). The combination of trimethoprim and sulfamethoxazole is generally effective against Chryseobacterium, Elizabethkingia, Sphingobacterium, and Myroides. (Kirby et al., 2004), (Winn et al., 2006), (Maraki et al., 2012). Rifampin is generally effective against Chryseobacterium, Elizabethkingia, and Myroides (Kirby et al., 2004), (Winn et al., 2006). Susceptibility tests show that minocycline is effective against Chryseobacterium, Elizabethkingia, and Myroides Fraser and Jorgensen (1997), (Bloch et al., 1997), (Winn et al., 2006).
Trimethoprim/ sulfamethoxazole Rifampin Minocycline
Experimental Therapies
Agent Name
Discussion
Piperacillin
In vitro studies suggest that E. meningoseptica is susceptible to piperacillin (Hoque et al., 2001), (Gunnarsson et al., 2002), (Chiu et al., 2000). In vitro studies have shown that E. meningoseptica is susceptible to minocycline (Bloch et al., 1997). The literature concerning vancomycin is confusing. Although in vitro testing indicates that E. meningoseptica is resistant to this antibiotic Fraser and Jorgensen (1997), (Bloch et al., 1997), (Kirby et al., 2004) infections have been successfully treated with vancomycin, usually in combination with other drugs such as ciprofloxacin (Gunnarsson et al., 2002) or rifampin (Di Pentima et al., 1998). It is unusual in these cases that vancomycin played an active role in therapy in these infections since E. meningoseptica is a gram-negative organism and should be intrinsically resistant to vancomycin. It is possible that the other drug in these combinations were responsible for the success.
Minocycline Vancomycin
Animal Models A mouse model for Chryseobacterium/Elizabethkingia has been described King (1959).
References Journal Citations Bellais S, Aubert D, Naas T, and Nordmann P (2000) Molecular and biochemical heterogeneity of class B carbapenem-hydrolyzing b-lactamases in Chryseobacterium meningosepticum Antimicrob. Antimicrobial agents and chemotherapy. 44: 1878–1886. Bellais S, Naas T, and Nordmann P (2002a) Molecular and biochemical characterization of Ambler class A extended-spectrum beta-lactamase CGA-1 from Chryseobacterium gleum Antimicrob. Antimicrobial agents and chemotherapy. 46: 966–970. Bellais S, Girlich D, Karim A, and Nordmann P (2002b) EBR-1, a novel Ambler subclass B1 beta-lactamase from Empedobacter brevis Antimicrob. Antimicrobial agents and chemotherapy. 46: 3223–3227. Blahova J, Kralikova K, Krcmery V Sr, and Kubonova K (1997) Hydrolysis of imipenem, meropenem, ceftazidime, and cefepime by multiresistant nosocomial strains of Sphingobacterium multivorum. European journal of clinical microbiology & infectious diseases: official publication of the European Society of Clinical Microbiology. 16: 178–180. Bloch KC, Nadarajah R, and Jacobs R (1997) Chryseobacterium meningosepticum: an emerging pathogen among immunocompromised adults. Report of 6 cases and literature review. Medicine 76: 30–41. Chiu CH, Waddingdon M, Hsieh WS, Greenberg D, Schreckenberger PC, and Carnahan AM (2000) Atypical Chryseobacterium meningosepticum and meningitis and sepsis in newborns and immunocompromised, Taiwan. Emerging infectious diseases. 6: 481–486.
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Di Pentima MC, Mason EO, and Kaplan SL (1998) In vitro antibiotic synergy against Flavobacterium meningosepticum: Implications for therapeutic options Clin. Infectious Diseases 26: 1169–1176. Fraser SL and Jorgensen JH (1997) Reappraisal of the antimicrobial susceptibilities of Chryseobacterium and Flavobacterium species and methods for reliable susceptibility testing Antimicrob. Antimicrobial agents and chemotherapy. 41: 2738–2741. Gonza´lez LJ and Vila A (2012) Carbapenem resistance in Elizabethkingia meningoseptica is mediated by metallo-b-lactamase BlaB Antimicrob. Antimicrobial agents and chemotherapy. 56: 1686–1692. Green BT, Green K, and Nolan PE (2001) Myroides odoratus cellulitis and bacteremia: Case report and review Scand. Journal of Infectious Diseases 33(2001): 932–934. Grimaldi D, Doloy A, Fichet J, Bourgeois E, Zuber B, Wajsfisz Mira JP, Poyart C, and Pe`ne F (2012) Necrotizing fasciitis and septic shock related to the uncommon gram-negative pathogen Sphingobacterium multivorum. Journal of clinical microbiology. 50: 202–203. Gunnarsson G, Baldursson H, and Hilmarsdottir I (2002) Septic arthritis caused by Chryseobacterium meningosepticum in an immunocompetent male Scand. Journal of Infectious Diseases 34: 299–300. Hoque SN, Graham J, Kaufmann ME, and Tabaqchali S (2001) Chryseobacterium (Flavobacterium) meningosepticum outbreak associated with colonization of water taps in a neonatal intensive care unit. Journal of Hospital Infection 47: 188–192. Kim KK, Kim MK, Lim JJ, Park HY, and Lee S-T (2005) Transfer of Chryseobacterium meningosepticum and Chryseobacterium miricola to Elizabethkingia gen. nov. as Elizabethkingia meningoseptica comb. nov. and Elizabethkingia miricola comb. nov. International Journal of Systematic and Evolutionary Microbiology 55: 1287–1293. King EO (1959) Studies on a group of previously unclassified bacteria associated with meningitis in infants. American Journal of Clinical Pathology 31: 241–247. Kirby JT, Sader HS, Walsh TR, and Jones RN (2004) Antimicrobial susceptibility and epidemiology of a worldwide collection of Chryseobacterium spp.: report from the SENTRY antimicrobial surveillance program (1997–2001). Journal of clinical microbiology. 42: 445–448. Mammeri H, Bellais S, and Nordmann P (2002) Chromosome-encoded beta-lactamases TUS-1 and MUS-1 from Myroides odoratus and Myroides odoratimimus (formerly Flavobacterium odoratum), new members of the lineage of molecular subclass B1 metelloenzymes. Antimicrobial agents and chemotherapy. 46: 3561–3567. Maraki S, Sarchianaki E, and Barbagadakis S (2012) Myroides odoratimimus soft tissue infection in an immunocompetent child following a pig bite: case report and literature review. The Brazilian journal of infectious diseases: an official publication of the Brazilian Society of Infectious Diseases. 16: 390–392. Matsumoto T, Nagata M, Ishimine N, Kawasaki K, Yamauchi K, Hidaka E, Kasuga E, Horiuchi K, Oana K, Kawakami Y, and Honda T (2012) Characterization of CIA-1, an Ambler class A extended-spectrum b-lactamase from Chryseobacterium indologenes. Antimicrobial Agents and Chemotherapy 56: 588–590. Perilli M, Caporale B, Celenza G, Pellegrini C, Docquier JD, Mezzatesta M, Rossolini GM, Stefani S, and Amicosante G (2007) Identification and characterization of a new metallo-b-lactamase, IND-5, from a clinical isolate of Chryseobacterium indologenes. Antimicrobial Agents and Chemotherapy 51: 2988–2990. Vancanneyt M, Segers P, Torck U, Hoste B, Bernardet J-F, Vandamme P, and Kersters K (1996) Reclassification of Flavobacterium odoratum (Stutzer 1929) strains to a new genius, Myroides, as Myroides odoratus comb. nov. and Myroides odoratimimus sp. nov. International Journal of Systematic Bacteriology 46: 926–932. Vandamme P, Bernardet J-F, Segers P, Kersters K, and Holmes B (1994) New perspectives in the classification of the flavobacteria: Description of Chryseobacterium gen. nov., Bergeyella gen. nov., and Empedobacter nom. rev. International Journal of Systematic Bacteriology 44: 827–831. Vessillier S, Docquier JD, Rival S, Frere JM, Galleni M, Amicosante G, and Rossolini GM (2002) Overproduction and biochemical characterization of the Chryseobacterium meningosepticum BlaB metello-beta-lactamase. Antimicrobial agents and chemotherapy. 46: 1921–1927. Book Citations Fisher RG (2014) Elizabethkingia and Chryseobacterium Species. In: Cherry JD, Harrison GJ, Kaplan SL, Steinbach WJ, and Hotez PJ (eds.) Feigin and Cherry”s textbook of pediatric infectious diseases, 7th ed., pp. 1578–1581. Philadelphia: Saunders, an Imprint of Elsevier Inc., Chapter 124. Forbes, B.A., Sahm, D.F., and Weissfeld, A.S. (2007). Chryseobacterium, Sphingobacterium, and similar organisms. Bailey & Scott’s Diagnostic Microbiology. 12th ed, Chapter 26, pp 358–362. Mosby, Inc. St. Louis, MO. Vaneechoutte M, Dijkshoorn L, Nemec A, Ka¨mpfer P, and Wauters G (2011) Acinetobacter, Chryseobacterium, Moraxella, and other nonfermentative gram-negative rods. In: Versalovic J, Carroll KC, Funke G, Jorgensen JH, Landry ML, and Warnock DW (eds.) Manual of Clinical Microbiology, 10th edn., pp. 714–738. Washington, D.C: ASM Press, Chapter 42. Winn WC Jr, Allen SD, Janda WM, Koneman EW, Procop GW, Schreckenberger PC, and Woods GL (2006) Koneman’s color atlas and textbook of diagnostic microbiology, 6th edn. Baltimore: Lippincott, Williams, & Wilkins.
Introduction Definition Classification Consequences Associated Disorders Epidemiology Pathophysiology Signs and Symptoms Standard Therapies Experimental Therapies Animal Models References
1 1 1 2 2 2 2 2 2 3 3 3
Introduction Chryseobacterium and related genera consist of bacteria previously classified in the genus Flavobacterium (Vandamme et al., 1994), (Vaneechoutte et al., 2011). All are gram-negative aerobic nonfermenting bacilli. The genus Flavobacterium, as it is currently defined, contains no pathogenic species. The former flavobacteria-like organisms that are potential human pathogens include those currently classified in the genera Chryseobacterium, Elizabethkingia, Myroides, Empedobacter, and Sphingobacterium. These are rare opportunistic pathogens of low virulence that may occasionally be involved in severe infections. Within this group, Elizabethkingia meningoseptica, formerly Chryseobacterium meningosepticum is the most common and important pathogen, particularly in neonatal meningitis. Infection is typically from an environmental source.
Definition Chryseobacterium and related bacteria are gram-negative nonfermenters that are oxidase positive and usually produce indole from tryptophan. Many produce pigmented colonies, typically various shades of yellow. There are approximately 80 species of Chryseobacterium, most of which are non-pathogenic environmental isolates, usually associated with moist environments. Chryseobacterium indologenes and Chryseobacterium gleum are human pathogens and are former members of the genus Flavobacterium (Vandamme et al., 1994), (Winn et al., 2006). C. meningosepticum, a rare but serious cause of neonatal meningitis, has been reclassified as Elizabethkingia meningoseptica (Kim et al., 2005). It is the most significant of the pathogens within this group Fisher (2014). Flavobacterium odoratum has been placed into the genus Myroides as two species, M. odoratus and M. odoratimimus (Vancanneyt et al., 1996). Unlike Chryseobacterium, Myroides are indole negative (Winn et al., 2006). They are rare isolates from human infections. Flavobacterium brevis has been reclassified as Empedobacter brevis (Vandamme et al., 1994). It is the only species in this genus and rarely a human pathogen. The two most commonly isolated species of Sphingobacterium from human infections are S. multivorum and S. spiritivorum, both of which are indole negative (Winn et al., 2006).
Classification The genus Flavobacterium has undergone extensive taxonomic revision (Vandamme et al., 1994), (Vancanneyt et al., 1996), (Vaneechoutte et al., 2011). The genus, as it was originally defined, consisted of phenotypically similar nonfermenting gramnegative bacteria that were oxidase positive and produced a yellow pigment. Analyses of rRNA, as well as other characteristics such as G + C content and DNA homology, made it clear that reclassification, as outlined above, was warranted. A list of recent taxonomic changes for Chryseobacterium, Elizabethkingia, Myroides, Empedobacter, and Sphingobacterium with links to 16S rRNA gene sequences can be found at http://www.bacterio.net/.
☆
Change History: August 2014. SJ Booth updated the text and added new references to the entire article.
Reference Module in Biomedical Research
http://dx.doi.org/10.1016/B978-0-12-801238-3.04922-9
1
2
Chryseobacterium Related Genera Infections
Consequences Infections with Chryseobacterium, Elizabethkingia, Myroides, Empedobacter, and Sphingobacterium are relatively rare, affecting primarily neonates or immunocompromised patients. Infections vary and include intraabdominal, wound, endocarditis, pneumonia, septicemia, and can be associated with indwelling devices such as catheters. (Bloch, Nadarajah, and Jacobs 1997) found that within the genus Chryseobacterium, C. meningosepticum (now Elizabethkingia meningoseptica) is the most common pathogen. In a review of the literature over a 10-year period, they found that 59% of 308 cultures positive for C. meningosepticum (E. meningoseptica) were associated with true infections (i.e. the isolated bacteria were not contaminants or passive colonizers). Of these infections, 65% were in infants less than three months of age and presented as meningitis (84% in neonates). The mortality rate in neonatal meningitis was high (57%). Bacteremia and pneumonia due to E. meningoseptica have been reported in neonates. Adult infections have several presentations, including pneumonia, septicemia, meningitis, endocarditis, postsurgical, postburn, etc. Although infections are usually in immunosuppressed individuals, (Gunnarsson et al., 2002) reported a case of septic arthritis due to C. meningosepticum (E. meningoseptica) in an immunocompetent patient. Empedobacter brevis is a rare nosocomial pathogen that is occasionally a cause of meningitis. Although it has been isolated from other clinical specimens such as blood and urine, its role in infections is unclear (Bellais et al., 2002b). Sphingobacterium infections, most of which are nosocomial (peritonitis, bacteremia, respiratory, etc.) are also relatively rare. S. multivorum was recently isolated from a patient with necrotizing fasciitis (Grimaldi et al., 2012).
Associated Disorders Myroides odoratus and M. odoratimimus are associated with various opportunistic infections, including cellulitis, bacteremia, and urinary tract infections (Green et al., 2001), (Mammeri et al., 2002), and (Maraki et al., 2012).
Epidemiology The genera Chryseobacterium, Elizabethkingia, Myroides, Empedobacter, and Sphingobacterium are primarily of environmental origin (soil, plants, water, food, etc.) and have been isolated from moist areas within hospitals. Some strains can survive in chlorinated municipal water supplies, giving them a selective advantage in hospital water systems (Winn et al., 2006), (Kirby et al., 2004). As a result of C. meningosepticum being reclassified as E. meningoseptica, C. indologenes is now the most common clinical isolate within the genus Chryseobacterium (Kirby et al., 2004), Fisher (2014).
Pathophysiology All of these organisms are of relatively low virulence. Specific virulence factors for most are not known. E. meningoseptica isolates may have a capsule that is potentially antiphagocytic, and they can produce proteases and a gelatinase that could be involved in tissue damage (Forbes et al., 2007). The specific role of these factors in the infectious process is unknown.
Signs and Symptoms There are no unique signs and symptoms of disease with any of these organisms. Diagnosis is based on isolation and identification of the specific organism.
Standard Therapies Species of Chryseobacterium, Elizabethkingia, Myroides, Empedobacter, and Sphingobacterium are intrinsically resistant to a wide range of antibiotics. Most produce beta-lactamases and are often resistant to aminoglycosides, tetracyclines, chloramphenicol, erythromycin, clindamycin, and teicoplanin (Kirby et al., 2004), (Vessillier et al., 2002), (Bellais et al., 2002a), (Bellais et al., 2002b), (Mammeri et al., 2002), (Vandamme et al., 1994), (Blahova et al., 1997), (Winn et al., 2006). Metallo-b-lactamases (MBL) have been described in E. meningoseptica Gonza´lez and Vila (2012). E. meningoseptica is unique in that it is the only known organism containing two chromosome-borne MBL genes (Bellais et al., 2000). An extended-spectrum b-lactamase (ESBL) was recently described for C. indologenes (Matsumoto et al., 2012). IND-type metallo-b-lactamases have also been described for this organism (Perilli et al., 2007). Myroides are usually resistant to the b-lactams, aminoglycosides, aztreonam and carbapenems (Winn et al., 2006), (Maraki et al., 2012). Empedobacter brevis infections are rare, but susceptibility patterns seem to parallel Chryseobacterium and Myroides. E. brevis has been shown to produce an Ambler subclass B1 b-lactamase (Bellais et al., 2002b). As a consequence of the
Chryseobacterium Related Genera Infections
3
rarity of Sphingobacterium infections, there are no established therapies. Sphingobacterium species are generally susceptible to the fluoroquinolones and trimethoprim/sulfamethoxazole (Winn et al., 2006). A recent isolate of S. multivorum in a case of necrotizing fasciitis was susceptible to amoxicillin-clavulanate, ticarcillin-clavulanate, fluoroquinolones, and trimethoprim/sulfamethoxazole (Grimaldi et al., 2012). Due to the variability in susceptibility patterns, and the discrepancies for therapeutic drugs in the literature, susceptibility testing should be performed on each isolate of any of the organisms discussed. Although there are no validated susceptibility testing methods (Forbes et al., 2007), a broth microdilution method was recommended by Fraser and Jorgensen (1997) and was used by (Kirby et al., 2004) for determining the minimal inhibitory concentrations (MIC’s) for approximately 20 strains each of C. meningosepticum (E. meningoseptica) and C. indologenes. The Etest may be useful for determining the MIC’s for some antibiotics (Winn et al., 2006).
Agent Name
Discussion
Fluoroquinolones
The fluoroquinolones are generally effective against Chryseobacterium, Elizabethkingia, Sphingobacterium, and Myroides (Winn et al., 2006), (Maraki et al., 2012). A case of septic arthritis due to E. meningoseptica was effectively treated with intravenous ciprofloxacin and vancomycin, followed after hospital discharge with oral ciprofloxacin (Gunnarsson et al., 2002). Resistance of E. meningoseptica to ciprofloxacin has been reported (Hoque et al., 2001). E. meningoseptica and C. indologenes are generally susceptible to garenoxacin, gatifloxacin, and levofloxacin (Kirby et al., 2004). The combination of trimethoprim and sulfamethoxazole is generally effective against Chryseobacterium, Elizabethkingia, Sphingobacterium, and Myroides. (Kirby et al., 2004), (Winn et al., 2006), (Maraki et al., 2012). Rifampin is generally effective against Chryseobacterium, Elizabethkingia, and Myroides (Kirby et al., 2004), (Winn et al., 2006). Susceptibility tests show that minocycline is effective against Chryseobacterium, Elizabethkingia, and Myroides Fraser and Jorgensen (1997), (Bloch et al., 1997), (Winn et al., 2006).
Trimethoprim/ sulfamethoxazole Rifampin Minocycline
Experimental Therapies
Agent Name
Discussion
Piperacillin
In vitro studies suggest that E. meningoseptica is susceptible to piperacillin (Hoque et al., 2001), (Gunnarsson et al., 2002), (Chiu et al., 2000). In vitro studies have shown that E. meningoseptica is susceptible to minocycline (Bloch et al., 1997). The literature concerning vancomycin is confusing. Although in vitro testing indicates that E. meningoseptica is resistant to this antibiotic Fraser and Jorgensen (1997), (Bloch et al., 1997), (Kirby et al., 2004) infections have been successfully treated with vancomycin, usually in combination with other drugs such as ciprofloxacin (Gunnarsson et al., 2002) or rifampin (Di Pentima et al., 1998). It is unusual in these cases that vancomycin played an active role in therapy in these infections since E. meningoseptica is a gram-negative organism and should be intrinsically resistant to vancomycin. It is possible that the other drug in these combinations were responsible for the success.
Minocycline Vancomycin
Animal Models A mouse model for Chryseobacterium/Elizabethkingia has been described King (1959).
References Journal Citations Bellais S, Aubert D, Naas T, and Nordmann P (2000) Molecular and biochemical heterogeneity of class B carbapenem-hydrolyzing b-lactamases in Chryseobacterium meningosepticum Antimicrob. Antimicrobial agents and chemotherapy. 44: 1878–1886. Bellais S, Naas T, and Nordmann P (2002a) Molecular and biochemical characterization of Ambler class A extended-spectrum beta-lactamase CGA-1 from Chryseobacterium gleum Antimicrob. Antimicrobial agents and chemotherapy. 46: 966–970. Bellais S, Girlich D, Karim A, and Nordmann P (2002b) EBR-1, a novel Ambler subclass B1 beta-lactamase from Empedobacter brevis Antimicrob. Antimicrobial agents and chemotherapy. 46: 3223–3227. Blahova J, Kralikova K, Krcmery V Sr, and Kubonova K (1997) Hydrolysis of imipenem, meropenem, ceftazidime, and cefepime by multiresistant nosocomial strains of Sphingobacterium multivorum. European journal of clinical microbiology & infectious diseases: official publication of the European Society of Clinical Microbiology. 16: 178–180. Bloch KC, Nadarajah R, and Jacobs R (1997) Chryseobacterium meningosepticum: an emerging pathogen among immunocompromised adults. Report of 6 cases and literature review. Medicine 76: 30–41. Chiu CH, Waddingdon M, Hsieh WS, Greenberg D, Schreckenberger PC, and Carnahan AM (2000) Atypical Chryseobacterium meningosepticum and meningitis and sepsis in newborns and immunocompromised, Taiwan. Emerging infectious diseases. 6: 481–486.
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Chryseobacterium Related Genera Infections
Di Pentima MC, Mason EO, and Kaplan SL (1998) In vitro antibiotic synergy against Flavobacterium meningosepticum: Implications for therapeutic options Clin. Infectious Diseases 26: 1169–1176. Fraser SL and Jorgensen JH (1997) Reappraisal of the antimicrobial susceptibilities of Chryseobacterium and Flavobacterium species and methods for reliable susceptibility testing Antimicrob. Antimicrobial agents and chemotherapy. 41: 2738–2741. Gonza´lez LJ and Vila A (2012) Carbapenem resistance in Elizabethkingia meningoseptica is mediated by metallo-b-lactamase BlaB Antimicrob. Antimicrobial agents and chemotherapy. 56: 1686–1692. Green BT, Green K, and Nolan PE (2001) Myroides odoratus cellulitis and bacteremia: Case report and review Scand. Journal of Infectious Diseases 33(2001): 932–934. Grimaldi D, Doloy A, Fichet J, Bourgeois E, Zuber B, Wajsfisz Mira JP, Poyart C, and Pe`ne F (2012) Necrotizing fasciitis and septic shock related to the uncommon gram-negative pathogen Sphingobacterium multivorum. Journal of clinical microbiology. 50: 202–203. Gunnarsson G, Baldursson H, and Hilmarsdottir I (2002) Septic arthritis caused by Chryseobacterium meningosepticum in an immunocompetent male Scand. Journal of Infectious Diseases 34: 299–300. Hoque SN, Graham J, Kaufmann ME, and Tabaqchali S (2001) Chryseobacterium (Flavobacterium) meningosepticum outbreak associated with colonization of water taps in a neonatal intensive care unit. Journal of Hospital Infection 47: 188–192. Kim KK, Kim MK, Lim JJ, Park HY, and Lee S-T (2005) Transfer of Chryseobacterium meningosepticum and Chryseobacterium miricola to Elizabethkingia gen. nov. as Elizabethkingia meningoseptica comb. nov. and Elizabethkingia miricola comb. nov. International Journal of Systematic and Evolutionary Microbiology 55: 1287–1293. King EO (1959) Studies on a group of previously unclassified bacteria associated with meningitis in infants. American Journal of Clinical Pathology 31: 241–247. Kirby JT, Sader HS, Walsh TR, and Jones RN (2004) Antimicrobial susceptibility and epidemiology of a worldwide collection of Chryseobacterium spp.: report from the SENTRY antimicrobial surveillance program (1997–2001). Journal of clinical microbiology. 42: 445–448. Mammeri H, Bellais S, and Nordmann P (2002) Chromosome-encoded beta-lactamases TUS-1 and MUS-1 from Myroides odoratus and Myroides odoratimimus (formerly Flavobacterium odoratum), new members of the lineage of molecular subclass B1 metelloenzymes. Antimicrobial agents and chemotherapy. 46: 3561–3567. Maraki S, Sarchianaki E, and Barbagadakis S (2012) Myroides odoratimimus soft tissue infection in an immunocompetent child following a pig bite: case report and literature review. The Brazilian journal of infectious diseases: an official publication of the Brazilian Society of Infectious Diseases. 16: 390–392. Matsumoto T, Nagata M, Ishimine N, Kawasaki K, Yamauchi K, Hidaka E, Kasuga E, Horiuchi K, Oana K, Kawakami Y, and Honda T (2012) Characterization of CIA-1, an Ambler class A extended-spectrum b-lactamase from Chryseobacterium indologenes. Antimicrobial Agents and Chemotherapy 56: 588–590. Perilli M, Caporale B, Celenza G, Pellegrini C, Docquier JD, Mezzatesta M, Rossolini GM, Stefani S, and Amicosante G (2007) Identification and characterization of a new metallo-b-lactamase, IND-5, from a clinical isolate of Chryseobacterium indologenes. Antimicrobial Agents and Chemotherapy 51: 2988–2990. Vancanneyt M, Segers P, Torck U, Hoste B, Bernardet J-F, Vandamme P, and Kersters K (1996) Reclassification of Flavobacterium odoratum (Stutzer 1929) strains to a new genius, Myroides, as Myroides odoratus comb. nov. and Myroides odoratimimus sp. nov. International Journal of Systematic Bacteriology 46: 926–932. Vandamme P, Bernardet J-F, Segers P, Kersters K, and Holmes B (1994) New perspectives in the classification of the flavobacteria: Description of Chryseobacterium gen. nov., Bergeyella gen. nov., and Empedobacter nom. rev. International Journal of Systematic Bacteriology 44: 827–831. Vessillier S, Docquier JD, Rival S, Frere JM, Galleni M, Amicosante G, and Rossolini GM (2002) Overproduction and biochemical characterization of the Chryseobacterium meningosepticum BlaB metello-beta-lactamase. Antimicrobial agents and chemotherapy. 46: 1921–1927. Book Citations Fisher RG (2014) Elizabethkingia and Chryseobacterium Species. In: Cherry JD, Harrison GJ, Kaplan SL, Steinbach WJ, and Hotez PJ (eds.) Feigin and Cherry”s textbook of pediatric infectious diseases, 7th ed., pp. 1578–1581. Philadelphia: Saunders, an Imprint of Elsevier Inc., Chapter 124. Forbes, B.A., Sahm, D.F., and Weissfeld, A.S. (2007). Chryseobacterium, Sphingobacterium, and similar organisms. Bailey & Scott’s Diagnostic Microbiology. 12th ed, Chapter 26, pp 358–362. Mosby, Inc. St. Louis, MO. Vaneechoutte M, Dijkshoorn L, Nemec A, Ka¨mpfer P, and Wauters G (2011) Acinetobacter, Chryseobacterium, Moraxella, and other nonfermentative gram-negative rods. In: Versalovic J, Carroll KC, Funke G, Jorgensen JH, Landry ML, and Warnock DW (eds.) Manual of Clinical Microbiology, 10th edn., pp. 714–738. Washington, D.C: ASM Press, Chapter 42. Winn WC Jr, Allen SD, Janda WM, Koneman EW, Procop GW, Schreckenberger PC, and Woods GL (2006) Koneman’s color atlas and textbook of diagnostic microbiology, 6th edn. Baltimore: Lippincott, Williams, & Wilkins.