Respiratory Isolation of Elizabethkingia meningoseptica during Prolonged Intensive Care Following Combat-Related Blast Chest Trauma: A Case Report

Abstract

Background: Elizabethkingia meningoseptica is an uncommon opportunistic Gram-negative non-fermenting bacterium associated with healthcare-associated infections, environmental persistence, diagnostic challenges, and extensive antimicrobial resistance. Evidence regarding E. meningoseptica in patients with severe traumatic injuries remains limited. Case Presentation: A 42-year-old man with a history of combat-related blast chest trauma was treated for bilateral destructive multisegmental pneumonia complicated by sepsis, acute respiratory failure, and acute kidney injury. His management included prolonged intensive care, mechanical ventilation, pleural drainage, invasive vascular access, and renal replacement therapy. Details of the antecedent blast injury were incomplete. The isolate was identified as E. meningoseptica by MALDI-TOF MS, with a reported log(score) value of 2.28. Serial cultures demonstrated changing polymicrobial flora. On 25 May 2026, sputum yielded E. meningoseptica at 10⁵ CFU/mL together with Providencia rettgeri (10⁴ CFU/mL) and Staphylococcus aureus (10³ CFU/mL). Species-level identification was reported by matrix-assisted laser desorption/ionisation time-of-flight mass spectrometry (MALDI-TOF MS); the instrument, reference-library version and identification score were not available in the retrospective record. A 26-mm inhibition zone was documented around a 5-µg ciprofloxacin disc. The archived protocol specified meat-peptone agar rather than Mueller–Hinton agar. As no species-specific EUCAST disk-diffusion breakpoint was available, the zone diameter was reported as a non-standard quantitative observation and was not assigned a susceptibility category. Conclusion: Recovery of E. meningoseptica after prolonged intensive-care exposure is microbiologically and epidemiologically relevant, but the polymicrobial sputum culture does not establish the organism as the sole cause of pneumonia or sepsis. Accurate species identification, validated antimicrobial susceptibility testing, and a risk-based assessment of possible healthcare-associated acquisition are essential.