Journal article
Recurrent spontaneous Escherichia coli meningitis in an adult: a case report
- Abstract:
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Objectives
The aim of this study was to characterize an unusual case of spontaneous, community-acquired Escherichia coli meningitis in an adult presenting to a general hospital in Kenya, where initial clinical recovery was followed by reinfection with an MDR, hospital-acquired strain.Patient and methods
An adult presented to a hospital in Kenya with meningitis symptoms. E. coli was cultured from CSF. Treatment with ceftriaxone was successful; however, the patient relapsed a few days later. E. coli was cultured from CSF and blood during the reinfection episode, though the patient died during admission. We sequenced the isolates using Illumina MiSeq and performed antimicrobial susceptibility testing, fitness and virulence assays on the bacteria.Results
The E. coli isolates from the two episodes were found to be distinct: the initial strain was ST88, serotype O8 H17 while the subsequent episode was caused by an ST167, serotype O101 H5 MDR strain. The ST88 strain was susceptible to all drugs except ampicillin and amoxicillin/clavulanate while the ST167 strain was MDR, including to all β-lactam drugs due to the presence of the carbapenemase gene blaNDM-5. The hospital-acquired ST167 strain was also resistant to newer drugs such as cefiderocol and eravacycline, which are currently not available locally, and had overall lower fitness and virulence in vitro compared with the initial infecting strain.Conclusions
Though less fit and virulent in vitro, the MDR strain was fatal, suggesting that host factors, rather than bacterial virulence, may have been of greater importance in this patient’s outcome.
- Publication status:
- Published
- Peer review status:
- Peer reviewed
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(Preview, Version of record, pdf, 382.1KB, Terms of use)
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- Publisher copy:
- 10.1093/jacamr/dlad029
Authors
- Publisher:
- Oxford University Press
- Journal:
- JAC-Antimicrobial Resistance More from this journal
- Volume:
- 5
- Issue:
- 2
- Article number:
- dlad029
- Publication date:
- 2023-03-28
- Acceptance date:
- 2023-03-05
- DOI:
- EISSN:
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2632-1823
- Language:
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English
- Keywords:
- Pubs id:
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1337433
- Local pid:
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pubs:1337433
- Deposit date:
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2023-05-23
- ARK identifier:
Terms of use
- Copyright holder:
- Amulele et al.
- Copyright date:
- 2023
- Rights statement:
- © The Author(s) 2023. Published by Oxford University Press on behalf of British Society for Antimicrobial Chemotherapy. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted reuse, distribution, and reproduction in any medium, provided the original work is properly cited.
- Licence:
- CC Attribution (CC BY)
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