Enterobacterial repetitive intergenic consensus-polymerase chain reaction analysis of a cluster of <i>Elizabethkingia meningoseptica</i> causing neonatal sepsis and meningitis

Objectives Elizabethkingia meningoseptica has emerged as a cause of healthcare-associated infections and outbreaks in intensive care units (ICUs) with high mortality because of its multidrug-resistant phenotype and adaptability to various environments. Strain typing is pivotal in detecting the cross-transmission of nosocomial pathogens and determining source tracing. Enterobacterial repetitive intergenic consensus-polymerase chain reaction (ERIC-PCR) typing has evolved as a simple, robust, cost-effective alternative to sequence-based typing methods for molecular epidemiological investigation of nosocomial outbreaks. The objectives of the study are to initiate an investigation of an outbreak after an alert of increased E. meningoseptica cases in neonatal ICU (NICU) (September 2021) and to conduct ERIC-PCR-based molecular epidemiological typing to assess clonal relatedness among the E. meningoseptica isolates of the outbreak. Materials and Methods E. meningoseptica isolates from blood and cerebrospinal fluid (CSF) were identified using standard microbiological techniques and final identification and antibacterial susceptibility by VITEK ® 2 Compact system (BioMérieux, France). Bacterial DNA was extracted using the spin column method (QIAprep Spin Miniprep kit-Qiagen). ERIC-PCR was performed following the procedure published in the literature. Statistical analysis Clonal relatedness among E. meningoseptica isolates was analyzed using ERIC-PCR fingerprints with the “Paleontological Statistics Software Package.” Results A cluster of 11 E. meningoseptica cases were encountered spanning over 15 months in NICU, and all were from both blood and CSF of 11 neonates, genetically related, pointing towards a common continuous source of the outbreak. Conclusions Heightened awareness among clinicians and microbiologists about E. meningoseptica , and stringent infection prevention and control measures are necessary to prevent such outbreaks in ICUs.