Narrative review suggests combination regimens over vancomycin monotherapy for Elizabethkingia meningoseptica infections

This narrative review examines the management of patients with Elizabethkingia meningoseptica infections, specifically comparing vancomycin monotherapy against combination regimens. The scope of the discussion centers on the challenges inherent in interpreting historical susceptibility data, which are frequently confounded by misidentification between E. meningoseptica and E. anophelis. Furthermore, the authors highlight that methodological variations in antimicrobial susceptibility testing significantly impact the reporting of vancomycin susceptibility, complicating treatment decisions.

The authors synthesize arguments favoring susceptibility-guided combination regimens rather than relying on vancomycin monotherapy. While mechanistic explanations, such as increased outer-membrane permeability and biofilm inhibition, are presented as plausible, the review explicitly states these mechanisms are not yet conclusively proven. Consequently, the evidence does not support definitive causal claims regarding specific drug mechanisms at this stage.

Limitations acknowledged by the authors include the lack of conclusive proof for proposed mechanisms and the variability in susceptibility testing methods. Safety data, including adverse events and tolerability, were not reported in this review. The practice relevance is framed cautiously, emphasizing the need for susceptibility-guided approaches while recognizing the current uncertainty surrounding optimal therapeutic strategies for these infections.