Nosocomial Escherichia coli meningitis in adults: Report of four cases and literature review
A 40-year-old Egyptian man was admitted to the neurosurgery service at Hamad general hospital. He had lower back pain of sudden onset and the straight-leg-raising test on 30 ° was positive. A central disc herniation was documented at L4-L5 by MRI of the lumber spine. Lumbar discectomy was performed with drain insertion. Four days later, the patients developed severe headache, vomiting and fever and there was obvious neck stiffness. Examination of CSF showed a leucocyte count of 56250/μl with 87% neutrophils, protein level of 298 mg/dl, and glucose level of <1.8 mg/dl. Gram staining of CSF demonstrated the presence of Gram-negative bacilli. CSF yielded ESBL E. coli sensitive to meropenem, piperacillin-tazobactam and gentamycin, but blood culture was negative. The patient was treated with meropenem and supportive treatment. After 15 days of treatment the patient's condition improved, allowing his discharge without any sequela other than his primary illness.