Pharmacist-Led Management of Elizabethkingia Keratitis: Precision Therapy Guided by Culture and mNGS to Improve Clinical Outcomes and Efficiency.

Authors

Pengyuan Du, Mengjie Zhou, Lusheng Wang, Xiaobi Zhang

Published in

Cornea. Jul 28, 2026. Epub Jul 28, 2026.

Abstract

This study evaluated the clinical efficacy of a pharmacist-led antimicrobial stewardship program augmented by metagenomic next-generation sequencing (mNGS) for managing rare, multidrug-resistant Elizabethkingia keratitis.
We conducted a retrospective case series of 5 male patients (mean age 56.4 years) diagnosed with Elizabethkingia keratitis (3 E. meningoseptica, 2 Elizabethkingia anophelis) between 2020 and 2025. Initial microbiological identification relied on corneal scraping culture and MALDI-TOF MS, while mNGS was strategically used in 1 complex case to identify potential copathogens. Clinical pharmacists provided interventions including minimum inhibitory concentration-guided therapy and the extemporaneous preparation of fortified antibiotic eye drops, such as 2% amikacin and 10% piperacillin/tazobactam. We assessed clinical outcomes, visual acuity (LogMAR), and the length of hospital stay.
Although conventional culture confirmed Elizabethkingia species in all cases, mNGS offered critical genomic insights in 1 complex case by detecting culture-negative co-pathogens Nocardia pneumoniae and Fusarium proliferatum, which directly guided the addition of targeted antifungal and antibacterial therapy. All Elizabethkingia isolates demonstrated extensive resistance to carbapenems and cephalosporins. After pharmacist-led interventions, mean visual acuity improved significantly from 1.56 ± 0.77 to 0.90 ± 0.25 LogMAR. Furthermore, the length of hospital stay decreased markedly from 40 days in the index case to an average of 10.7 ± 4.9 days in the final 3 cases as diagnostic and therapeutic protocols were refined.
Integrating clinical pharmacists within a multidisciplinary team, supported by mNGS for comprehensive polymicrobial detection, enables precision pharmacotherapy for multidrug-resistant Elizabethkingia keratitis. This approach promotes successful ocular salvage and visual recovery while substantially improving clinical efficiency through shortened hospitalization.

PMID:
42561044
Bibliographic data and abstract were imported from PubMed on 07 Aug 2026.

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