title: Lethal neonatal meningoencephalitis caused by multi-drug resistant, highly virulent Escherichia coli.
abstract: Neonatal meningitis is a rare but devastating condition. Multi-drug resistant (MDR) bacteria represent a substantial global health risk. This study reports on an aggressive case of lethal neonatal meningitis due to a MDR Escherichia coli (serotype O75:H5:K1). Serotyping, MDR pattern and phylogenetic typing revealed that this strain is an emergent and highly virulent neonatal meningitis E. coli isolate. The isolate was resistant to both ampicillin and gentamicin; antibiotics currently used for empiric neonatal sepsis treatment. The strain was also positive for multiple virulence genes including K1 capsule, fimbrial adhesion fimH, siderophore receptors iroN, fyuA and iutA, secreted autotransporter toxin sat, membrane associated proteases ompA and ompT, type II polysaccharide synthesis genes (kpsMTII) and pathogenicity-associated island (PAI)-associated malX gene. The presence of highly-virulent MDR organisms isolated in neonates underscores the need to implement rapid drug resistance diagnostic methods and should prompt consideration of alternate empiric therapy in neonates with Gram negative meningitis.
authors.affiliation: a Department of Pediatrics , Vanderbilt University , Nashville , TN , USA ;
authors.forename: Junaid
authors.initials: J
authors.lastname: Iqbal
authors.affiliation: a Department of Pediatrics , Vanderbilt University , Nashville , TN , USA ;
authors.forename: Kevin R
authors.initials: KR
authors.lastname: Dufendach
authors.affiliation: b Department of Neurosurgery , Vanderbilt University , Nashville , TN , USA ;
authors.forename: John C
authors.initials: JC
authors.lastname: Wellons
authors.affiliation: c Department of Pathology, Microbiology and Immunology , Vanderbilt University , Nashville , TN , USA ;
authors.forename: Maria G
authors.initials: MG
authors.lastname: Kuba
authors.affiliation: c Department of Pathology, Microbiology and Immunology , Vanderbilt University , Nashville , TN , USA ;
authors.forename: Hilary H
authors.initials: HH
authors.lastname: Nickols
authors.affiliation: a Department of Pediatrics , Vanderbilt University , Nashville , TN , USA ;
authors.forename: Oscar G
authors.initials: OG
authors.lastname: Gómez-Duarte
authors.affiliation: d Department of Pediatrics , University of Florida , Gainesville , FL , USA.
authors.forename: James L
authors.initials: JL
authors.lastname: Wynn
mesh_terms: D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D004269:DNA, Bacterial / Q000032:analysis; D024901:Drug Resistance, Multiple, Bacterial; D004926:Escherichia coli / Q000302:isolation & purification* / Q000472:pathogenicity; D004927:Escherichia coli Infections / Q000175:diagnosis / Q000382:microbiology* / Q000473:pathology; D017809:Fatal Outcome; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008590:Meningoencephalitis / Q000175:diagnosis / Q000382:microbiology* / Q000473:pathology
chemical_list: D000900:Anti-Bacterial Agents; D004269:DNA, Bacterial
keywords: Escherichia coli; hypervirulence; meningitis; meningoencephalitis; multi-drug resistance; neonate