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Lethal neonatal meningoencephalitis caused by multi-drug resistant, highly virulent Escherichia coli

Junaid Iqbal1, Kevin R Dufendach1, John C Wellons2

  • 1a Department of Pediatrics , Vanderbilt University , Nashville , TN , USA ;

Infectious Diseases (London, England)
|April 1, 2016
PubMed

Insights

A lethal case of neonatal meningitis was caused by multi-drug resistant Escherichia coli. This aggressive strain highlights the urgent need for rapid diagnostics and alternative treatments for neonatal sepsis.

Area of Science:

  • Neonatal infectious diseases
  • Bacteriology
  • Genetics of virulence

Background:

  • Neonatal meningitis is a severe infection with high mortality.
  • Multi-drug resistant (MDR) bacteria pose a significant global health threat, particularly in vulnerable neonatal populations.
  • Current empiric antibiotic treatments for neonatal sepsis may be ineffective against emerging MDR strains.

Observation:

  • An aggressive and lethal case of neonatal meningitis was identified.
  • The causative agent was a multi-drug resistant (MDR) Escherichia coli (serotype O75:H5:K1).
  • This isolate exhibited resistance to ampicillin and gentamicin, common antibiotics for neonatal sepsis.

Findings:

  • Phylogenetic and serotyping analysis identified the E. coli strain as emergent and highly virulent.
  • The isolate possessed numerous virulence factors, including K1 capsule, fimbrial adhesion (fimH), siderophore receptors (iroN, fyuA, iutA), secreted autotransporter toxin (sat), and outer membrane proteases (ompA, ompT).
  • Genes associated with type II polysaccharide synthesis (kpsMTII) and a pathogenicity island (malX) were also present.

Implications:

  • The emergence of highly virulent MDR Gram-negative bacteria in neonates necessitates improved diagnostic methods for rapid drug resistance detection.
  • Clinical consideration of alternative empiric antibiotic therapies for neonatal meningitis is crucial.
  • This case underscores the need for enhanced surveillance and antimicrobial stewardship to combat MDR infections in neonatal intensive care units.
Keywords:
Escherichia colihypervirulencemeningitismeningoencephalitismulti-drug resistanceneonate

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