{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,13]],"date-time":"2026-04-13T06:46:23Z","timestamp":1776062783738,"version":"3.50.1"},"reference-count":41,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,4,13]],"date-time":"2026-04-13T00:00:00Z","timestamp":1776038400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Microbiol."],"abstract":"<jats:p>\n                    <jats:italic>Elizabethkingia meningoseptica<\/jats:italic>\n                    , an environmental, non-fermenting Gram-negative bacillus, poses a serious clinical challenge due to its intrinsic multidrug resistance. Paradoxically, the pathogen exhibits exceptional\n                    <jats:italic>in vitro<\/jats:italic>\n                    susceptibility to vancomycin, a glycopeptide antibiotic normally directed only against Gram-positive organisms. This review systematically synthesizes recent evidence\u2014published since earlier key reviews\u2014on this paradoxical susceptibility. The review clarifies taxonomic evolution and identification challenges within the genus\n                    <jats:italic>Elizabethkingia<\/jats:italic>\n                    , highlighting how frequent misidentification between\n                    <jats:italic>E. meningoseptica<\/jats:italic>\n                    and\n                    <jats:italic>E. anophelis<\/jats:italic>\n                    has confounded historical susceptibility data. It proceeds to critically evaluate methodological variations in antimicrobial susceptibility testing and their impact on vancomycin susceptibility reporting. It discusses emerging mechanistic insights, including hypothesized increased outer-membrane permeability and biofilm inhibition at sub-minimum inhibitory concentrations, as plausible but not yet conclusively proven explanations for vancomycin activity. Finally, it proposes evidence-based treatment strategies, emphasizing susceptibility-guided combination regimens over vancomycin monotherapy. This updated synthesis aims to provide both theoretical grounding and pragmatic clinical guidance for managing multidrug-resistant\n                    <jats:italic>Elizabethkingia<\/jats:italic>\n                    infections.\n                  <\/jats:p>","DOI":"10.3389\/fmicb.2026.1767980","type":"journal-article","created":{"date-parts":[[2026,4,13]],"date-time":"2026-04-13T05:48:01Z","timestamp":1776059281000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Unusual susceptibility to vancomycin in Elizabethkingia meningoseptica: mechanisms and clinical implications"],"prefix":"10.3389","volume":"17","author":[{"given":"Qi","family":"Sun","sequence":"first","affiliation":[{"name":"College of Medical Technology, Beihua University","place":["Jilin, China"]},{"name":"Department of Laboratory Medicine, The First Hospital of Jilin University","place":["Changchun, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Miao","family":"Sun","sequence":"additional","affiliation":[{"name":"Department of Laboratory Medicine, The First Hospital of Jilin University","place":["Changchun, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jia","family":"Du","sequence":"additional","affiliation":[{"name":"College of Medical Technology, Beihua University","place":["Jilin, China"]},{"name":"Department of Laboratory Medicine, The First Hospital of Jilin University","place":["Changchun, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Heyuan","family":"Guan","sequence":"additional","affiliation":[{"name":"College of Medical Technology, Beihua University","place":["Jilin, China"]},{"name":"Department of Laboratory Medicine, The First Hospital of Jilin University","place":["Changchun, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ze","family":"Li","sequence":"additional","affiliation":[{"name":"College of Medical Technology, Beihua University","place":["Jilin, China"]},{"name":"Department of Laboratory Medicine, The First Hospital of Jilin University","place":["Changchun, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Chun","family":"Yang","sequence":"additional","affiliation":[{"name":"Department of Laboratory Medicine, The First Hospital of Jilin University","place":["Changchun, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Baoyu","family":"Sun","sequence":"additional","affiliation":[{"name":"College of Medical Technology, Beihua University","place":["Jilin, China"]},{"name":"Department of Laboratory Medicine, The First Hospital of Jilin University","place":["Changchun, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jiancheng","family":"Xu","sequence":"additional","affiliation":[{"name":"Department of Laboratory Medicine, The First Hospital of Jilin University","place":["Changchun, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Wei","family":"Xia","sequence":"additional","affiliation":[{"name":"College of Medical Technology, Beihua University","place":["Jilin, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1965","published-online":{"date-parts":[[2026,4,13]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"840","DOI":"10.15537\/smj.2024.45.8.20240279","article-title":"Epidemiology, clinical profiles, and antimicrobial susceptibility of Elizabethkingia meningoseptica infections: insights from a tertiary care hospital in Saudi Arabia","volume":"45","author":"Alhuthil","year":"2024","journal-title":"Saudi Med. 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Environ. Saf."},{"key":"ref22","doi-asserted-by":"publisher","first-page":"1287","DOI":"10.1099\/ijs.0.63541-0","article-title":"Transfer of Chryseobacterium meningosepticum and Chryseobacterium miricola to Elizabethkingia gen. nov. as Elizabethkingia meningoseptica comb. nov. and Elizabethkingia miricola comb. nov","volume":"55","author":"Kim","year":"2005","journal-title":"Int. J. Syst. Evol. Microbiol."},{"key":"ref23","doi-asserted-by":"publisher","first-page":"241","DOI":"10.1093\/ajcp\/31.3.241","article-title":"Studies on a group of previously unclassified bacteria associated with meningitis in infants","volume":"31","author":"King","year":"1959","journal-title":"Am. J. Clin. Pathol."},{"key":"ref24","doi-asserted-by":"publisher","first-page":"653","DOI":"10.1093\/jac\/dkaa499","article-title":"Susceptibility of Elizabethkingia spp. to commonly tested and novel antibiotics and concordance between broth microdilution and automated testing methods","volume":"76","author":"Kuo","year":"2021","journal-title":"J. Antimicrob. Chemother."},{"key":"ref25","doi-asserted-by":"publisher","first-page":"e01338-22","DOI":"10.1128\/spectrum.01338-22","article-title":"Effect of intragenomic sequence heterogeneity among multiple 16S rRNA genes on species identification of Elizabethkingia","volume":"10","author":"Lin","year":"2022","journal-title":"Microbiol. Spectrum"},{"key":"ref26","doi-asserted-by":"publisher","first-page":"17012","DOI":"10.3390\/ijms242317012","article-title":"In vitro and in vivo antimicrobial activities of vancomycin and rifampin against Elizabethkingia anophelis","volume":"24","author":"Lin","year":"2023","journal-title":"Int. J. Mol. Sci."},{"key":"ref27","doi-asserted-by":"publisher","first-page":"538","DOI":"10.3390\/jcm7120538","article-title":"Comparison of clinical manifestations, antimicrobial susceptibility patterns, and mutations of fluoroquinolone target genes between Elizabethkingia meningoseptica and Elizabethkingia anophelis isolated in Taiwan","volume":"7","author":"Lin","year":"2018","journal-title":"J. Clin. Med."},{"key":"ref28","doi-asserted-by":"publisher","first-page":"295","DOI":"10.3390\/microorganisms7090295","article-title":"Elizabethkingia infections in humans: from genomics to clinics","volume":"7","author":"Lin","year":"2019","journal-title":"Microorganisms"},{"key":"ref29","doi-asserted-by":"publisher","first-page":"13007","DOI":"10.3390\/ijms241613007","article-title":"Validation of 16S rRNA and complete rpoB gene sequence analysis for the identification of Elizabethkingia species","volume":"24","author":"Lin","year":"2023","journal-title":"Int. J. Mol. 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Clin. Med."},{"key":"ref35","doi-asserted-by":"publisher","first-page":"100084","DOI":"10.1016\/j.medmic.2023.100084","article-title":"Biofilms: understanding the structure and contribution towards bacterial resistance in antibiotics","volume":"16","author":"Shree","year":"2023","journal-title":"Med. Microecol."},{"key":"ref36","doi-asserted-by":"publisher","first-page":"145","DOI":"10.1089\/mdr.2022.0179","article-title":"Treatment failure due to adaptive resistance mechanisms in a severe and complicated bloodstream infection due to Elizabethkingia meningoseptica","volume":"29","author":"Stewart","year":"2023","journal-title":"Microb. Drug Resist."},{"key":"ref37","doi-asserted-by":"publisher","first-page":"654","DOI":"10.1002\/pro.3819","article-title":"Molecular mechanisms of vancomycin resistance","volume":"29","author":"Stogios","year":"2020","journal-title":"Protein Sci."},{"key":"ref38","doi-asserted-by":"publisher","first-page":"e02454-24","DOI":"10.1128\/spectrum.02454-24","article-title":"Identification of Elizabethkingia species by MALDI-TOF MS proteotyping","volume":"13","author":"Takei","year":"2025","journal-title":"Microbiol. Spectrum"},{"key":"ref39","doi-asserted-by":"publisher","first-page":"249","DOI":"10.3390\/molecules24020249","article-title":"Polymyxin derivatives that sensitize gram-negative bacteria to other antibiotics","volume":"24","author":"Vaara","year":"2019","journal-title":"Molecules"},{"key":"ref40","first-page":"827","article-title":"New perspectives in the classification of the Flavobacteria: description of Chryseobacterium gen. nov., Bergeyella gen. nov., and Empedobacter nom. rev","volume":"44","author":"Vandamme","year":"1994","journal-title":"Int. J. Syst. Evol. Microbiol."},{"key":"ref41","doi-asserted-by":"publisher","first-page":"2048","DOI":"10.1093\/jac\/dkae210","article-title":"Imipenem reduces the efficacy of vancomycin against Elizabethkingia species","volume":"79","author":"Yang","year":"2024","journal-title":"J. Antimicrob. Chemother."},{"key":"ref42","doi-asserted-by":"publisher","first-page":"882","DOI":"10.3390\/microorganisms10050882","article-title":"Epidemiology and characteristics of Elizabethkingia spp. infections in Southeast Asia","volume":"10","author":"Zajmi","year":"2022","journal-title":"Microorganisms"}],"container-title":["Frontiers in Microbiology"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fmicb.2026.1767980\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,4,13]],"date-time":"2026-04-13T05:48:03Z","timestamp":1776059283000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fmicb.2026.1767980\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,4,13]]},"references-count":41,"alternative-id":["10.3389\/fmicb.2026.1767980"],"URL":"https:\/\/doi.org\/10.3389\/fmicb.2026.1767980","relation":{},"ISSN":["1664-302X"],"issn-type":[{"value":"1664-302X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,4,13]]},"article-number":"1767980"}}