title: E. coli multiresistant meningitis after transrectal prostate biopsy.
abstract: Escherichia coli meningitis is a frequent pathology in children younger than 3 years old, but is an uncommon disease in adults. E. coli infection is the main cause of intrahospital bacteremia as a consequence of the employment of different medical procedures. Our patient, male, 69 years old, presented with fever, progressive difficulty in breathing, and shivers 24 h after transrectal prostate biopsy, with an absence of any other symptoms. He received prophylactic treatment with ciprofloxacin and later empirical treatment with ampicillin and tobramicin. After that, the patient presented with fever, headache, behavioral changes, somnolence, disorientation, a fluctuating level of conscience, cutaneous widespread pallor, and acute urinary retention. On physical exploration, we observed generalized hypoventilation, Glasgow 10, stiffness of the neck, inconclusive Kernig; the remaining neurological exploration was normal. Systematic of blood: leukocytes = 8,510/mm3 (94.5% polymorphonuclear), platelet = 87,000/mm3, pH = 7.51, pCO2 = 28.8 mmHg, pO2 = 61 mmHg, O2 saturation = 93.8%, and remaining values were normal. Chest X- ray, cranial CT scan, urine cultures were normal. Blood culture: E. coli. CSF: glucose <0.4 g/l, total proteins = 3.05 g/l, PMN = 7 cells. Microscopic examination of the CSF: Gram-negative bacilli; CSF's culture: abundant E. coli. The case of acute meningitis by multiresistant E. coli after transrectal prostate biopsy presented demonstrates that antibiotic prevention with ciprofloxacin is not absolutely risk free. Besides the use of antibiotic prevention for multiresistant microorganisms, the urologist and other physicians involved in the procedure must not forget that the rate of major complications of transrectal prostate biopsy is 1%, especially when it is performed in patients who will not benefit from that biopsy.
authors.affiliation: Department of Clinical Immunology, Hospital Clínico San Carlos, Madrid, Spain. dianalecsandru2@yahoo.es
authors.forename: Diana
authors.initials: D
authors.lastname: Alecsandru
authors.forename: Israel
authors.initials: I
authors.lastname: Gestoso
authors.forename: Ana
authors.initials: A
authors.lastname: Romero
authors.forename: Alfonso
authors.initials: A
authors.lastname: Martinez
authors.forename: Ana
authors.initials: A
authors.lastname: Garcia
authors.forename: Julio
authors.initials: J
authors.lastname: Lobo
authors.forename: M Ruiz
authors.initials: MR
authors.lastname: Yagüe
mesh_terms: D000208:Acute Disease; D000368:Aged; D000667:Ampicillin / Q000008:administration & dosage; D000900:Anti-Bacterial Agents / Q000494:pharmacology; D019072:Antibiotic Prophylaxis; D001706:Biopsy / Q000009:adverse effects*; D002939:Ciprofloxacin / Q000008:administration & dosage; D024881:Drug Resistance, Bacterial; D004926:Escherichia coli / Q000378:metabolism*; D006801:Humans; D008297:Male; D008581:Meningitis / Q000209:etiology* / Q000382:microbiology*; D011467:Prostate / Q000382:microbiology*; D014031:Tobramycin / Q000008:administration & dosage
chemical_list: D000900:Anti-Bacterial Agents; D002939:Ciprofloxacin; D000667:Ampicillin; D014031:Tobramycin