[Ceftriaxon -resistant E.coli meningitis in a diabetic patient]

ABSTRACT

A 57-year-old Iranian woman with a 4-day history of fever, malaise, and disorientation is presented. Signs of meningeal irritation were evident on examination. The patient's medical history was remarkable for diabetes mellitus, and hypertension with several admissions to hospital. Ampicilin, ceftriaxon, and vancomycin were administered for possible bacterial meningitis. A brain CT scan without contrast was unremarkable. Analysis of CSF revealed compatible values for bacterial meningitis. Culture of urine and CSF samples led to isolation of E. coli. The patient's clinical condition showed no improvement after 3 days. Four days following hospitalization, re-culture of CSF sample again produced positive result for E. coli. Using disk diffusion method, the isolate was found to be resistant to ceftriaxone and imipenem but sensitive to ciprofloxacin. Ceftriaxone was replaced by IV ciprofloxacin plus ceftazidime. The results of repeated analyses of CSF were indicative of clinical improvement with negative result for CSF culture. Ciprofloxacin and ceftazidime were continued for a total of 21 days. The patient remained asymptomatic with no recurrence