Elizabethkingia anophelis bacteremia is associated with clinically significant infections and high mortality

Unlike Elizabethkingia meningoseptica , the clinical importance of E. anophelis is poorly understood. We determined the clinical and molecular epidemiology of bacteremia caused by Elizabethkingia- like species from five regional hospitals in Hong Kong. Among 45 episodes of Elizabethkingia -like bacteremia, 21 were caused by Elizabethkingia , including 17 E. anophelis , three E. meningoseptica and one E. miricola ; while 24 were caused by other diverse genera/species, as determined by 16S rRNA gene sequencing. Of the 17 cases of E. anophelis bacteremia, 15 (88%) were clinically significant. The most common diagnosis was pneumonia (n = 5), followed by catheter-related bacteremia (n = 4), neonatal meningitis (n = 3), nosocomial bacteremia (n = 2) and neutropenic fever (n = 1). E. anophelis bacteremia was commonly associated with complications and carried 23.5% mortality. In contrast, of the 24 episodes of bacteremia due to non- Elizabethkingia species, 16 (67%) were clinically insignificant. Compared to non- Elizabethkingia bacteremia, Elizabethkingia bacteremia was associated with more clinically significant infections ( P < 0.01) and positive cultures from other sites ( P < 0.01), less polymicrobial bacteremia ( P < 0.01) and higher complication ( P < 0.05) and mortality ( P < 0.05) rates. Elizabethkingia bacteremia is predominantly caused by E. anophelis instead of E. meningoseptica . Elizabethkingia bacteremia, especially due to E. anophelis , carries significant morbidity and mortality and should be considered clinically significant unless proven otherwise.