<i>Elizabethkingia meningoseptica</i> Meningitis in Neonates: Clinical Profile, Resistance Patterns, and Outcomes

Introduction Elizabethkingia meningoseptica (EM) is a rare but serious cause of neonatal meningitis associated with high morbidity and mortality. However, clinical data from Eastern India remain limited. This study aimed to delineate the clinical profile, antimicrobial susceptibility patterns, and treatment outcomes of neonates with EM meningitis. Methods Five neonates diagnosed with EM meningitis between July and October 2024 in a Level-3 neonatal intensive care unit (NICU) of a tertiary care center in Eastern India were included. Descriptive statistics were used to analyze demographic and clinical characteristics, antibiotic susceptibility, and treatment outcomes. Long-term neurodevelopmental status was assessed using the Global Hammersmith Infant Neurological Examination (HINE). Results Of the five neonates, 80% were preterm, with a median gestational age of 31 weeks (IQR: 29.5-35.4). They presented at a median age of 7 days (range: 4-22) with lethargy in all cases (100%), followed by apnea, feeding intolerance, and seizures. EM was isolated from all blood samples and 80% of cerebrospinal fluid (CSF) cultures, with susceptibility only to minocycline (100%), levofloxacin (100%), ciprofloxacin (80%), and cefoperazone/sulbactam (60%). The overall mortality was 20%. Among survivors, 75% developed post-meningitic hydrocephalus, and 50% of those had poor neurological outcomes at 6 months (HINE &lt;50). Despite an extensive environmental survey, the source of infection remained unidentified; however, no new cases occurred following reinforcement of stringent infection prevention measures. Conclusion EM meningitis predominantly affects preterm neonates and is associated with high mortality and significant neurodevelopmental sequelae. Early diagnosis, appropriate antimicrobial therapy, and robust infection control practices are crucial for improving outcomes.