[Multidrug-resistant Enterobacteriaceae meningoencephalitis in the Guinean-Malian area]

Extended-spectrum beta-lactamase-secreting Enterobacteriaceae (ESBL-E) infections constitute a real global public health problem, particularly in sub-Saharan Africa. We report here two cases of ESBL-E meningoencephalitis in young female patients occurring in a gestational context observed at the infectious and tropical diseases department of the Point G university hospital in Bamako. The first woman, who recently had an abortion, was being treated with ceftriaxone when she was admitted for meningeal syndrome and pyramidal syndrome associated with brain damage. Escherichia coli resistant to penicillins and cephalosporins was isolated from cerebrospinal fluid (CSF), blood and a purulent genital swab. She recovered under meropenem treatment for 21 days, with few sequelae.The second had given birth in the weeks prior to the onset of generalized infection. She was admitted for meningeal syndrome and pyramidal syndrome associated with several cerebral lesions disclosed by the CT scan. Multidrug-resistant E. coli was isolated from CSF and genital purulent sample. She recovered (with sequelae) under treatment with meropenem for 21 days. These two observations show that female genital infections (postpartum or post abortum) with E. coli can cause forms as serious as meningoencephalitis, in addition to the abortion they cause. ESBL-E -producing strains may be involved and represent a major therapeutic challenge. Better infection prevention and control would prevent multi-drug-resistant infections and their spread. Regulating the use of carbapenems and other antibiotics still effective against multi-resistant bacterial strains within the framework of global health (one health) would avert an incurable pandemic of highly resistant and emerging bacteria (HRB).