First Initial community-acquired meningitis due to extended-spectrum beta-lactamase producing Escherichia coli complicated with multiple aortic mycotic aneurysms.docVIP

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First Initial community-acquired meningitis due to extended-spectrum beta-lactamase producing Escherichia coli complicated with multiple aortic mycotic aneurysms.doc

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First Initial community-acquired meningitis due to extended-spectrum beta-lactamase producing Escherichia coli complicated with multiple aortic mycotic aneurysms

Weyrichetal.AnnalsofClinicalMicrobiologyandAntimicrobials2012,11:4 /content/11/1/4 CASE REPORT OpenAccess FirstInitialcommunity-acquiredmeningitisdue toextended-spectrumbeta-lactamaseproducing Escherichiacolicomplicatedwithmultipleaortic mycoticaneurysms PierreWeyrich1,NicolasEttahar1,LaurenceLegout1*,AgnesMeybeck2,OlivierLeroy2andEricSenneville1 Abstract Wereportthefirstcaseofextended-spectrumbeta-lactamaseproducingE.colicommunity-acquiredmeningitis complicatedwithmultipleaorticmycoticaneurysms.Becauseoftheacuteaneurysmexpansionwithpossible impendingruptureon2abdominalCTscan,thepatientunderwentpromptvascularsurgeryandbroadspectrum antibiotictherapybuthediedofahemorrhagicshock.Extended-spectrumbeta-lactamaseproducingE.coliwas identifiedfrombothbloodandcerebrospinalfluidculturebeforevasculartreatment.Thepresentcasereportdoes nothoweverchangetheguidelinesofGramnegativebacteriameningitisinadults. Keywords:aorticmycoticaneurysm,ESBLproducingEscherichiacoli ,meningitis Introduction wasfound.WBCcountwas3.85G/L;hemoglobin rate, Adultcommunity-acquiredmeningitisduetoE.coliisa 14.6g/dl;plateletscount,64G/L;C-reactiveproteinrate rareentity.Itgenerallyoccursinpatientswithcompro- (CRP),292mg/L;procalcitoninrate,21.9ng/mlandpro- misedimmunestatusorcirrhosis.Whendirectexamina- thrombine rate, 44%. The renal and hepatic functions tionofthecerebrospinalfluid(CSF)showsthepresenceof werenormal. CSFexamination showed440cells/mm3, Gramnegativebacilli(GNB),currentguidelinesrecom- (neutrophils 62%,lymphocytes 29%)withaglucoseand mendtheuseofa3rdgenerationcephalosporin(cefotax- protein rate at0.01 mmol/l and10.35 g/l, respectively. imeorceftriaxone)[1,2].Wehereinreportthefirstcaseof ThechestX-ray,electrocardiogramandcerebralcomputer extended-spectrum beta-lactamase (ESBL) producing tomography (CT) scan were normal. The patient was E.colicommunity-acquiredmeningitiscomplicatedwith transferredtotheintensivecareunitfewhoursafterhis multipleaor