{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,9,30]],"date-time":"2025-09-30T00:02:38Z","timestamp":1759190558624,"version":"3.44.0"},"reference-count":23,"publisher":"BMJ","issue":"9","license":[{"start":{"date-parts":[[2025,9,28]],"date-time":"2025-09-28T00:00:00Z","timestamp":1759017600000},"content-version":"unspecified","delay-in-days":27,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Case Rep"],"accepted":{"date-parts":[[2025,9,10]]},"published-print":{"date-parts":[[2025,9]]},"abstract":"<jats:p>\n                  <jats:italic>Elizabethkingia<\/jats:italic> species, including <jats:italic>Elizabethkingia miricola<\/jats:italic>, are rare opportunistic Gram-negative bacteria. We present a case of <jats:italic>E. miricola<\/jats:italic> bloodstream infection associated with a polymicrobial mediastinitis. A male in his 70s underwent an elective Nissen fundoplication, deteriorated on day one post surgery and was transferred to the intensive care unit. Blood cultures revealed <jats:italic>E. miricola<\/jats:italic>. A CT scan revealed an air and fluid collection posterior to the heart, moderate bilateral pleural effusions, an extensive pneumomediastinum, pockets of free air within the upper abdomen and a splenic infarct. A mediastinal drain and pleural drains were inserted, which cultured <jats:italic>E. miricola<\/jats:italic>, <jats:italic>Candida albicans, Staphylococcus aureus<\/jats:italic> and anaerobes. The patient was treated with piperacillin-tazobactam and fluconazole with a good response. <jats:italic>E. miricola<\/jats:italic> is intrinsically resistant to multiple antibiotic classes, including carbapenems and aminoglycosides. The lack of published cases combined with resistance makes management challenging. Our case highlighted the need for a combination of antibiotic therapy and source control.<\/jats:p>","DOI":"10.1136\/bcr-2025-267000","type":"journal-article","created":{"date-parts":[[2025,9,29]],"date-time":"2025-09-29T04:25:23Z","timestamp":1759119923000},"page":"e267000","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["<i>Elizabethkingia miricola<\/i> mediastinitis and bacteraemia"],"prefix":"10.1136","volume":"18","author":[{"given":"Grace","family":"Rothwell-Kelly","sequence":"first","affiliation":[{"name":"Department of Clinical Microbiology, St. Vincent\u2019s University Hospital, Dublin, Ireland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Clarice","family":"Egan","sequence":"additional","affiliation":[{"name":"Department of Clinical Microbiology, St. Vincent\u2019s University Hospital, Dublin, Ireland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kirsten","family":"Schaffer","sequence":"additional","affiliation":[{"name":"Department of Clinical Microbiology, St. Vincent\u2019s University Hospital, Dublin, Ireland"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2025,9,28]]},"reference":[{"key":"2025092821251729000_18.9.e267000.1","unstructured":"EUCAST guidance on when there are no breakpoints in breakpoint tables. 2024. 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