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.

Keywords:

• Escherichia coli
• meningitis
• meningoencephalitis
• multi-drug resistance
• hypervirulence
• neonate

Acknowledgements

We are grateful to Dr Janice Williams at the Electron Microscopy Core Laboratory, Vanderbilt University for technical assistance and helpful discussions.

Disclosure statement

The contents of this work are solely the responsibility of the authors and do not necessarily represent official views of the Thrasher Fund, National Center for Advancing Translational Sciences or the National Institutes of Health.

Funding information

This work was funded in part by the Department of Pediatrics, Vanderbilt University School of Medicine to OGG-D; NIH K08GM106143, Thrasher Research Fund to JLW; CTSA award UL1TR000445 from the National Center for Advancing Translational Sciences to KRD and T32 HD068256 – ‘Preventing prematurity and poor pregnancy outcomes’ to KRD.