Table 1.

Clinical characteristics, antimicrobial treatment and clinical outcomes for patients with E. meningoseptica sterile site infections

Case	Age (years)	Sex	Location	Underlying condition	Date of isolation of blood culture	LOS prior to infection	CVL	Line removal (day of illness)	Meningitis	Antibiotic sensitivity	Empirical treatment	Treatment	Total duration of antibiotic treatment (days)	Time to first negative CS (days)	Neurological morbidity	Death
1	7	F	CICU	Acute lymphoblastic leukaemia	28 June 2011	4 days	Yes	No	No	TZP/SXT	CAZ/AMK/MNZ	TZP/SXT	14	3	No	No
2	9	F	CICU	Chronic granulocytic leukaemia	4 July 2011	5 months	Yes	Yes (1)	No	TZP, resistant to SXT, CIP	MEM/VAN	TZP/CIP	8 (till demise)	0	na	Yes
3†	8	F	Onco	Refractory acute myeloid leukaemia	21 July 2011	19 days	Yes	Yes (2)	No	TZP/SXT, resistant to CIP	MEM/AMK/VAN	SXT/CIP	21 days	1	na	Yes† *
4	0.5	F	NICU	Preterm 33 weeks, necrotizing enterocolitis	3 Mar 2012	6 months	Yes	No	No	TZP/SXT/CIP	MEM/AMK/VAN	TZP/SXT	14	5	Yes. Motor skills delay. Reduced academic performance	No
5	2	M	Onco	Pre-B acute lymphoblastic leukaemia	10 Apr 2012	1 day	Yes	Yes (8)	No	TZP/SXT, resistant to CIP	CAZ/GEN	TZP/SXT	14	44**	No	No
6	9.5	M	CICU	Pre-B acute lymphoblastic leukaemia	18 Nov 2012	2 months	Yes	No	No	TZP/SXT/MXF/LVX, resistant to CIP	MEM/VAN/CAZ	TZP/SXT	2 (till demise)	0	na	Yes
7	2	M	Ward	Haemophilia A with left subdural haematoma	23 Apr 2013	14 days	No	na	Yes	TZP/SXT/MXF/LVX, resistant to CIP	CRO	SXT/MXF, TZPa	42	2	Yes. Cerebral palsy, severe GDD	No
8	5	M	Ward	Extensive burns	15 June 2013	3 months	Yes	No	No	TZP/SXT/MXF/LVX, resistant to CIP	TZP	TZP/LVX, SXTb	14	9	No	No
9	2	M	Onco	Recurrent grade 4 pineoblastoma	30 June 2014	1 day	Yes	Yes (4)	No	TZP/SXT/MXF/LVX/CIP	TZP	TZP/CIP, SXTc	14	3	na	Yes*
10	20 days	F	NICU	Preterm 23 weeks	30 Sept 2014	20 days	Yes	Yes (14)	No	TZP/SXT/MXF/LVX/CIP	CXA/GEN	TZP/CIP, SXTd	14	8	Yes. Moderate GDD	No
11	13 days	F	NICU	Preterm 33 weeks, necrotizing enterocolitis	13 Apr 15	13 days	Yes	Yes (2)	Yes	TZP/RIF, resistant to SXT, CIP, MXF, LVX, MI	CXA/GEN/MNZ	TZP/RIF	21	9	No	No
12	30 days	F	NICU	Preterm 24 weeks	22 July 2015	30 days	Yes	Yes (2)	Yes	TZP/SXT/LVX/RIF	CXA/AMK	TZP/SXT	21	4	Yes. Moderate GDD	No
13	12 days	M	Ward	Term infant, left pelvi-ureteric junction obstruction	26 Apr 2016	1 day	No	na	Yes	TZP/SXT/MXF/LVX/CIP	AMP/GEN	TZP/SXT	21	6	Yes. Mild developmental delay. Hydrocephalus with VP shunt inserted	No

a, TZP discontinued due to allergic reaction; b, SXT discontinued due to allergic reaction; c, SXT discontinued due to plans for initiation of chemotherapy; d, SXT discontinued due to acute kidney injury.

^*Patient died due to underlying oncological condition.

^**Blood cultures were not performed on a regular basis due to palliative care.

^†Patient 3 had two episodes of E. meningoseptica bacteraemia. During the first episode, she achieved a microbiological cure with intravenous trimethoprim/sulfamethoxazole and ciprofloxacin. Parents requested discharge against medical advice, and she was sent home on oral trimethoprim/sulfamethoxazole and ciprofloxacin to complete 21 days’ total treatment. She was readmitted 1 month later with a more resistant strain of E. meningoseptica bacteraemia [sensitive to TZP/CC/MI/MXF (intermediate) and resistant to SXT and CIP]. Although she managed to achieve a microbiological cure with a combination of piperacillin/tazobactam, clindamycin, minocycline and moxifloxacin, she succumbed to her underlying oncological condition.

AMK, amikacin; AMP, ampicillin; CAZ, ceftazidime; CC, clindamycin; CIP, ciprofloxacin; CRO, ceftriaxone; CVL, central venous line; CXA, cloxacillin; GDD, global developmental delay; GEN, gentamicin; LVX, levofloxacin; MEM, meropenem; MI, minocycline; MNZ, metronidazole; MXF, moxifloxacin; na, not applicable; RIF, rifampicin; SXT, trimethoprim/sulfamethoxazole; TZP, piperacillin- tazobactam; VAN, vancomycin; VP, ventriculoperitoneal shunt.