Professor Jiun-Nong Lin
Professor
School of Medicine, College of Medicine
I-Shou University
Taiwan

Elizabethkingia has been sporadically reported to cause human infections.  More recently, novel species, E. anophelis, has emerged as a cause of life-threatening infection in humans, in particular among immunocompromised patients. Several E. anophelis infections have been reported in Singapore, Hong Kong, Africa and the USA.¹ Appropriate antimicrobial therapy is important in the successful treatment of this pathogen that has multiple drug resistance.

Professor Jiun-Nong Lin shares insights into the clinical characteristics of E. anophelis infections in Taiwan and antimicrobial agents, including fluoroquinolones, that can be used to treat this life-threatening infection.

Q1. What is the prevalence of E. anophelis infection in Taiwan? Has there been a rise in infections in recent years?

The actual prevalence rate of E. anophelis infection in Taiwan is still unknown. According to our research, the number of infections of E. anophelis did increase in recent years.¹

Q2. What are the key factors for the emergence of E. anaphelis infections? What predicts mortality in patients with E. anophelis infections?

Most patients (85.1%) infected with E. anophelis have comorbidities, including malignancy, cardiovascular diseases and diabetes. Inappropriate empirical antimicrobial therapy is the only independent risk factor for mortality in patients infected with E. anophelis.

Q3. What is the treatment strategy for E. anophelis infection? In particular, how can antimicrobial susceptibility testing assist treatment strategy? 

Clinicians usually rely on antimicrobial susceptibility testing to treat patients with infections. For emerging infections, such as E. anophelis, the information for empirical antibiotics is frequently not available.  Antimicrobial susceptibility testing will provide valuable information for the treatment of such emerging infections.

Q4. What are the considerations when using fluoroquinolones (e.g., levofloxacin) for the treatment of E. anophelis infections?

Based on susceptibility testing, minocycline and levofloxacin are the potential drugs of choice for patients with E. anophelis infection. However, intravenous minocycline is not available in many countries, including Taiwan. In contrast, both oral and intravenous forms of levofloxacin are available worldwide. Therefore, levofloxacin is considered an appropriate therapy for E. anophelis infection. Our recent in vivo animal study also supports that levofloxacin is the drug of choice for E. anophelis infection.²

Q5. What are the considerations and precautions when prescribing levofloxacin?

There are only few complications of levofloxacin, such as arrhythmia, gastrointestinal discomfort and connective tissue injury. Levofloxacin is a reliable and safe antimicrobial agent for many pathogens, including E. anophelis. However, incorrect use of antibiotics will result in the emergence of drug-resistant microbes. All clinicians should keep in mind the importance of appropriate use of antimicrobial agents, including levofloxacin.

References

1. Lin JN, Lai CH, Yang CH, Huang YH, Lin HH. J Antimicrob Chemother 2018; 73: 2497–2502. doi:10.1093/jac/dky197.
2. Lin JN, Lai CH, Huang YH, Yang CH. Antibiotics. 2021; 10(3):285. https://doi.org/10.3390/antibiotics10030285.