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Integrating Diagnostic Approaches in Infant Bacterial Meningitis Caused by a Non-K1 Escherichia coli: A Case Report

Gianluca Vrenna1, Marilena Agosta2, Valeria Fox1

  • 1Multimodal Laboratory Medicine, Bambino Gesù Children's Hospital, IRCCS, 00165 Rome, Italy.

Antibiotics (Basel, Switzerland)
|January 8, 2025
PubMed

Insights

A case of infant meningitis caused by a multidrug-resistant Escherichia coli strain highlights the limitations of standard diagnostic panels. Advanced molecular methods like whole-genome sequencing are crucial for identifying emerging resistant pathogens and improving patient outcomes.

Area of Science:

  • Pediatric Infectious Diseases
  • Molecular Diagnostics
  • Antimicrobial Resistance

Background:

  • Infant meningitis, especially from Escherichia coli, is a severe threat, particularly in vulnerable infants.
  • Prompt diagnosis and effective treatment are critical due to similar symptoms across various pathogens.
  • Rapid identification of pathogens and resistance mechanisms is essential for timely intervention.

Observation:

  • An 8-month-old infant presented with fever, diarrhea, and seizures, diagnosed with meningitis.
  • Initial treatment with ceftriaxone was ineffective, and the patient's condition deteriorated.
  • Standard meningitis molecular panels failed to detect the pathogen.

Findings:

  • Off-label use of a blood culture identification panel detected a non-K1 Escherichia coli strain with CTX-M extended-spectrum beta-lactamase (ESBL) resistance.
  • Whole-genome sequencing identified the strain as belonging to the highly virulent and resistant ST131 group.
  • Despite rapid diagnostics and adjusted therapy, the infant succumbed to the highly virulent and multidrug-resistant infection.

Implications:

  • This case underscores the need for advanced molecular diagnostics, including whole-genome sequencing, to complement traditional methods.
  • Diagnostic tools must evolve to detect emerging resistant strains, such as non-K1 E. coli, for comprehensive meningitis diagnosis.
  • Continuous adaptation of diagnostic panels is vital for addressing challenges posed by highly virulent and resistant pathogens.
Abstract

Keywords:
FilmArrayinfant meningitisnon-K1 Escherichia coliwhole-genome sequencing

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