Lethal neonatal meningoencephalitis caused by multi-drug resistant, highly virulent <i>Escherichia coli</i>

Neonatal meningitis is a rare but devastating condition. Multi-drug resistant (MDR) bacteria represent a substantial global health risk. This study reports on an aggressive case of lethal neonatal meningitis due to a MDR <i>Escherichia coli</i> (serotype O75:H5:K1). Serotyping, MDR pattern and phylogenetic typing revealed that this strain is an emergent and highly virulent neonatal meningitis <i>E. coli</i> isolate. The isolate was resistant to both ampicillin and gentamicin; antibiotics currently used for empiric neonatal sepsis treatment. The strain was also positive for multiple virulence genes including K1 capsule, fimbrial adhesion <i>fimH</i>, siderophore receptors <i>iroN</i>, <i>fyuA</i> and <i>iutA</i>, secreted autotransporter toxin <i>sat</i>, membrane associated proteases <i>ompA</i> and <i>ompT</i>, type II polysaccharide synthesis genes (<i>kpsMTII</i>) and pathogenicity-associated island (PAI)-associated <i>malX</i> gene. The presence of highly-virulent MDR organisms isolated in neonates underscores the need to implement rapid drug resistance diagnostic methods and should prompt consideration of alternate empiric therapy in neonates with Gram negative meningitis.