Meningitis caused by extended-spectrum beta-lactamase-producing Escherichia coli in infants in France: alpha case series

Objectives: We report the first case series focusing on clinical and biological characteristics of meningitis caused by ESBL-producing Escherichia coli in infants. Methods: Between 2001 and 2020, data on all cases of E. coli meningitis were prospectively collected from a network of 259 paediatric wards and 168 microbiology laboratories in France. We analysed the clinical and biological characteristics, short-term complications and long-term sequelae of ESBL-producing E. coli meningitis cases in patients <6 months old. Results: In total, 548 cases of E. coli paediatric meningitis were reported. ESBL-producing E. coli represented 12 (2.2%) cases. We included 10 patients aged <6 months old. Eight (80%) patients presented at least one sign of clinical severity: six needed mechanical ventilation, three presented signs of shock and one was in a coma. The overall short-term prognosis was good, with only one meningitis-attributed death in the first hours of care. All surviving children received carbapenems for a median of 21 days (range 9-28). Two relapses occurred, including one in a patient who received only 14 days of imipenem. We reported no long-term sequelae at a median follow-up of 20 months. Conclusions: Meropenem seems to be the treatment of choice for ESBL-producing E. coli meningitis in children and needs to be given as early as possible (<48 h) and for at least 21 days. Maternal colonization or infection with ESBL-producing Enterobacteriaceae needs to be reported to the neonatal or paediatric ICU team, in order to adapt the empirical antibiotic therapy.

Automated summary

This study reports the clinical and biological characteristics of meningitis caused by ESBL-producing E. coli in infants. Data from a network of pediatric wards and microbiology laboratories in France were analyzed. The study suggests that Meropenem is the treatment of choice for ESBL-producing E. coli meningitis in children, and should be initiated within 48 hours and continued for at least 21 days.