Case Report: Fatal Outcome for a Preterm Newborn With Meningitis Caused by Extended-Spectrum β-Lactamase-Producing Escherichia coli Sequence Type 1193

In this case report, we describe an extended-spectrum beta-lactamase (ESBL) - strain of sequence type (ST) 1193, a novel, virulent, multidrug-resistant (MDR) clone with a rapid global spread. ST 1193 has been more commonly associated with invasive disease than other ESBL- STs. To our knowledge, this is the first known case in Sweden where a newborn died of an ESBL- ST 1193 meningitis. We emphasize that the clinical knowledge about the properties of certain MDR-clones should be increased. A moderately preterm boy was born after preterm prolonged rupture of membranes. The mother had an ESBL- urinary tract infection during pregnancy. At 36 h of age he developed signs of infection and was given first-line therapy for early onset sepsis. Thereafter he developed seizures. The treatment was changed to cover suspected meningitis. Culture showed growth of the same ESBL- ST 1193 strain in the child's blood and cerebrospinal fluid, as well as in the mother's urine. Antibiotics were adapted. His condition deteriorated and he developed fulminant septic shock with treatment-resistant seizures. The boy passed away at 3 days of age. This case highlights the risk of delay in diagnosis when a marking for carriage of MDR-bacteria is falsely removed from a medical record of a pregnant women. Further, it demonstrates that ESBL- ST 1193 infection in neonates can be fatal. Thus, studies regarding virulence factors of ESBL- infections in pregnant women and their children are needed to understand the association between this infection and severe invasive disease in newborn children.