Журнал нефрологии и терапии

Successfully Treatment of Proteus Mirabilis - Associated Meningitis in a Neonate by Carbapenem - Case Report and Review

Abstract

Suzan Nasser, Moran Avni, Boshra N, Jerdev Michael, AZ Seed, Bayan H, Ehsan N, Haia N and Wael Nasser

Proteus Mirabilis is a Gram-negative, facultatively anaerobic, rod-shaped bacterium. Proteus Mirabilis is most frequently associated with infections of the urinary tract, especially in complicated or catheter-associated urinary tract infections.

Although P. mirabilis is not commonly implicated as a causative organism in neonatal meningitis, its recognition is so important because the disease progresses rapidly and has poor prognosis. We present a case of a 14-day-old full term male infant that was admitted to our Emergency Department due to fever up to 39.6, with no vomiting, cough or diarrhea. According to the parents the infant underwent a circumcision 6 days before the fever started, in addition at home a father and sister had flue like symptoms. Sepsis workup was done and antibiotics was started include cefotaxime, amoxcilin, gentamycin. On the second day of admission, the CSF culture revealed a growth of P. mirabilis. No growth was reported from urine and blood cultures.

Based on the possibility of AmpC β lactamase production that may be induced by the Cefotaxime, the antibiotic therapy was changed to IV meropenem 120 mg/kg/day divided q8h that was given for 3 weeks. Under this treatment, the baby was getting better with normal vital signs, and repeated normal physical examination including neurological examination. Several repeated brain US scans were also normal. Repeated CSF examination after 72 hours of treatment with meropenem revealed sterile fluid. At discharge, the patient had normal physical, and specifically neurological, and ophthalmological examinations, as well as normal brain US.