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

Adult community-acquired meningitis due to E. coli is a rare entity. It generally occurs in patients with compromised immune status or cirrhosis. When direct examination of the cerebrospinal fluid (CSF) shows the presence of Gram negative bacilli (GNB), current guidelines recommend the use of a 3rd generation cephalosporin (cefotaxime or ceftriaxone) [1,2]. We herein report the first case of extended-spectrum beta-lactamase (ESBL) producing E. coli community-acquired meningitis complicated with multiple aortic mycotic aneurysms.In September 2010, a 59-year-old patient with a history of chronic alcohol and tobacco consumption was admitted to the emergency unit for consciousness disorders and fever. Two days before his admission, the patient had presented headache and nausea.At admission (09/28), physical examination revealed a frank meningeal irritation, consciousness disorders with a Glasgow Coma Scale (GCS) of 12. The patient's hemodynamic status was stable and, no other physical abnormality was found. WBC count was 3.85 G/L; hemoglobin rate, 14.6 g/dl; platelets count, 64 G/L; C-reactive protein rate (CRP), 292 mg/L; procalcitonin rate, 21.9 ng/ml and prothrombine rate, 44%. The renal and hepatic functions were normal. CSF examination showed 440 cells/mm3, (neutrophils 62%, lymphocytes 29%) with a glucose and protein rate at 0.01 mmol/l and 10.35 g/l, respectively. The chest X-ray, electrocardiogram and cerebral computer tomography (CT) scan were normal. The patient was transferred to the intensive care unit few hours after his admission because of a rapid deterioration of consciousness (GCS 6) and the occurrence of septic shock. Mechanical ventilation, volume resuscitation, hydrocortisone hemisuccinate, vasopressors, platelets transfusion and intravenous empirical broad spectrum antibiotic therapy were administered. The patient received cefotaxime 18 g/24 h, amoxicillin 12 g/24 h and gentamicin 460 mg/24 h. Both CSF and blood culture yielded an ESBL producing E.