Nosocomial Escherichia coli meningitis in adults: Report of four cases and literature review
A 52-year-old Sudanese man brought to the emergency department because of loss of consciousness. His medical history was remarkable for hypertension and diabetes mellitus. Cranial CT showed large cerebellar hematoma with dilatation of supratentorial ventricular system associated with impending conization. An urgent craniotomy and hematoma evacuation was carried out and EVD was performed. Patient remained unconscious but with stable vitals. Four days later, the patient developed fever. CSF examination revealed the following values; leucocytes 6083/μl with 97% neutrophils, glucose 32.4 mg/dl and protein 250 mg/dl. CSF and blood cultures yielded E. coli resistant to ampicillin, ceftazidime, ceftriaxone, cefepime, piperacillin-tazobactam, ciprofloxacin and amoxi-clavulinate and sensitive to meropenem. Despite antibiotic treatment with meropenem and supportive therapy, the patient deteriorated and died 4 weeks after admission probably due to overwhelming sepsis in addition to his primary illness.