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Paper text:
elizabethkingia meningoseptica , previously known as chryseobacterium meningosepticum , is a gram - negative bacillus that is widely distributed in nature .
e. meningoseptica was originally described as flavobacterium meningosepticum in 1959 by an american bacteriologist elizabeth o. king .
it is ubiquitously found in soil and water and it has also been recovered from hospital environments .
e. meningoseptica is nonmotile , oxidase - positive and a medically important nonfermentative gram - negative bacillus that has been associated with a broad range of infectious etiologies , notably outbreaks of neonatal meningitis , . in adults ,
e. meningoseptica can also cause pneumonia , endocarditis , and bacteremia primarily in immunocompromised individuals , .
for instance , in a study of 118 cases of e. meningoseptica bacteremia , the most common underlying predisposing conditions were malignancies ( 36% ) and diabetes mellitus ( 25% ) .
recognition of e. meningoseptica is paramount for clinicians since multi - drug resistance is common for this organism .
we report a case of bacteremia due to e. meningoseptica in a patient who necessitated chronic hemodialysis therapy secondary to a longstanding history of diabetic nephropathy .
a 68-year - old male with a history of diabetes mellitus , hypertension , and end - stage renal disease was in his usual status until five days prior to presentation when he developed fatigue , anorexia and fevers .
the patient 's medical history was otherwise unremarkable and he was up - to - date with his annual physical evaluation . on physical examination , the patient appeared ill .
the temperature was 101.0  f , blood pressure 103/64  mm hg , pulse 107 beats per minute , respirations 21 breaths per minute and oxygen saturation 97% on room air .
his heart sounds revealed tachycardia without murmurs and his lungs disclosed crackles on the right side .
laboratory studies revealed a white blood cell count of 10,800  cells / mm with 87% polymorphonuclear leukocytes , hemoglobin of 10.5  g / dl , and platelets of 214,000  mm .
mmol / l , potassium 4.4  mmol / l , bicarbonate 20  meq / l , urea nitrogen 31  mg / dl , and creatinine 2.3  mg / dl .
two sets of cultures of the blood obtained through the hemodialysis catheter at the time of admission grew gram - negative bacilli after 48  h of incubation .
another two sets of the blood cultures collected through a peripheral vein also grew gram - negative bacilli .
subsequently , it was identified as e. meningoseptica based on further biochemical reactions and automated bacteriology identification system in the laboratory .
the patient was treated with intravenous vancomycin for 4 weeks based on the susceptibility results ; the isolate was considered susceptible to vancomycin with a minimal inhibitory concentration ( mic ) value of 1  g / ml using broth microdilution methodology .
the hemodialysis catheter was removed and the catheter tip sent for culture demonstrated no growth .
e. meningoseptica is ubiquitously found in soil and water . because of its survival in hospital environments
, nosocomial outbreaks can occur as a result of exposure to a contaminated water source or medical devices .
notably , it has been reported to cause neonatal meningitis associated with nosocomial outbreaks , . in adults ,
potential risk factors for developing e. meningoseptica bacteremia identified in the literature include malignancies , steroid use , diabetes mellitus , neutropenia , and organ transplant , . our patient had a longstanding history of diabetic nephropathy which necessitated chronic hemodialysis therapy .
importantly , e. meningoseptica bacteremia has been described in patients with a wide array of renal pathology which required chronic hemodialysis therapy , , , , , .
our patient potentially developed catheter - related bacteremia considering its ability to contaminate medical devices and the blood cultures positive for e. meningoseptica through the hemodialysis catheter .
it is usually resistant to many antibiotics commonly used to treat infections caused by gram - negative bacteria .
it is generally resistant to aminoglycosides , and -lactam agents , including carbapenems , due to the production of extended spectrum -lactamases ( esbl ) and metallo--lactamases .
in contrast , e. meningoseptica is often susceptible to agents used for gram - positive bacteria .
vancomycin has been described as an active agent against e. meningoseptica 
 , , particularly in cases of infantile meningitis due to e. meningoseptica 
 , .
however , contradictory results with high vancomycin mic values against e. meningoseptica have also been reported , .
although the advanced molecular techniques have become available to detect drug resistant genes for metallo--lactamase and esbl , the mechanism of action of antimicrobial agents used for gram - positive bacteria against e. meningoseptica has not been well described in the literature , . currently , validated susceptibility testing methods are not available and mic breakpoints have not been established by the clinical and laboratory standards institute ( clsi ) for e. meningoseptica .
therefore , when e. meningoseptica is isolated from clinical specimens , its pathogenic potential associated with clinical significance should be thoroughly evaluated .
bacteremia due to e. meningoseptica primarily occurs in immunocompromised individuals , including those with various nephropathy which necessitated hemodialysis therapy .
recognition of e. meningoseptica is of critical importance for clinicians since conventional empirical treatment against gram - negative bacteria may result in unfavorable outcome given its unique antimicrobial susceptible pattern .
a copy of the written consent is available for review by the editor - in - chief of this journal on request .
elizabethkingia meningoseptica is a nonfermentative gram - negative bacillus that is ubiquitously found in hospital environments and as such , it has been associated with various nosocomial infections . 
 immunocompromised individuals are particularly at increased risk for developing severe infections due to e. meningoseptica , including bacteremia . 
 e. meningoseptica is resistant to multiple antimicrobials commonly used for gram - negative bacteria and conventional empirical antimicrobials targeting those organisms may result in unfavorable outcome . 
 we report a case of bacteremia due to e. meningoseptica in a patient who necessitated chronic hemodialysis therapy to heighten awareness of this emerging pathogen among patients on hemodialysis .