Abstract
Intracranial infections caused by multidrug-resistant Gram-negative bacterium have led to considerable mortality due to extremely limited treatment options. Herein, we firstly reported a clinical carbapenem-resistant Escherichia coli isolate coharboring blaNDM–5 and blaCTX–M–65 from a patient with post-craniotomy meningitis. The carbapenem-resistant Escherichia coli strain CNEC001 belonging to Sequence Type 410 was only susceptible to amikacin and tigecycline, both of which have poor penetration through the blood-brain barrier (BBB). The blaCTX–M–65 gene was expressed on a 135,794 bp IncY plasmid. The blaNDM–5 gene was located on a genomic island region of an IncX3-type plasmid pNDM5-CNEC001. Based on the characteristics of the strain, we presented the successful treatment protocol of intravenous (IV) tigecycline and amikacin combined with intrathecal (ITH) amikacin in this study. Intracranial infection caused by Escherichia coli coharboring blaNDM–5 and blaCTX–M–65 is rare and fatal. Continuous surveillance and infection control measures for such strain need critical attention in clinical settings.
Highlights
Intracranial infection caused by carbapenem-resistant Enterobacteriaceae (CRE) is one of the most devastating complications following neurosurgery and a serious nosocomial infection with high mortality (Fang et al, 2017)
We report a case of secondary meningitis caused by an E. coli sequence type 410 (ST410) strain coproducing New Delhi metallo-beta-lactamase (NDM)-5 and CTX-M-65 for the first time, which was successfully treated by intravenous (IV) tigecycline and amikacin in combination with intrathecal (ITH) amikacin
Comparison between NDM-5producing ST167 and ST410 E. coli isolates previously reported in China reveals that NDM-5-producing ST167 E. coli strains were recovered from more clinical samples
Summary
Intracranial infection caused by carbapenem-resistant Enterobacteriaceae (CRE) is one of the most devastating complications following neurosurgery and a serious nosocomial infection with high mortality (Fang et al, 2017). Limited antibiotics options due to the high resistance profile of CRE and poor blood-brain barrier (BBB) penetration complicate the treatment of CRE-related meningitis/encephalitis. Treated Carbapenem-Resistant E. coli Meningitis (Berger, 2011). NDM-5-producing Escherichia coli can lead to severe infections in diverse anatomical locations. Intracranial infections due to E. coli producing NDM-5 and the related treatment experience are scarce. We report a case of secondary meningitis caused by an E. coli ST410 strain coproducing NDM-5 and CTX-M-65 for the first time, which was successfully treated by intravenous (IV) tigecycline and amikacin in combination with intrathecal (ITH) amikacin. Genomic and phenotypic characteristics of the strain are described in detail
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