Two Cases of Escherichia coli Meningitis Developing After Transrectal Prostate Biopsy

Abstract

Transrectal prostate biopsy (TPB) is a commonly used invasive technique for the diagnosis of prostate cancer. Escherichia coli is a rare cause of adult meningitis. It can cause nosocomial meningitis after invasive procedures. In this paper, we present two cases of E. coli meningitis developing after TPB. The first case was a 65-year-old man who was admitted to the emergency service with fever and unconsciousness two days after TPB. He had neck stiffness, leukocytosis, and high C-reactive protein (CRP) levels. His cerebrospinal fluid (CSF) had turbid appearance, low glucose and high protein levels. More than 1000/mm3 leukocytes were seen on direct microscopy, and gram-negative bacilli were observed. Ceftriaxone 2 g q12h was started. CSF culture yielded E. coli susceptible to ceftriaxone. Concomitant urine and blood cultures were sterile. The second case was a 69-year-old man admitted with fever and unconsciousness six days after TPB. He had neck stiffness, leukocytosis and high CRP levels. His CSF had purulent appearance, low glucose and high protein levels. On microscopy, there were 800 leukocytes/mm3. Ceftriaxone 2 g q12h was started. CSF culture yielded extended spectrum beta-lactamase producer E. coli. Treatment was changed to meropenem 6 mg daily. Both patients were cured with the three-week antibiotic treatment. After TPB, resistant microorganisms can be involved in the etiology of severe bacterial infections; carbapenems can be used until culture results are available.

Keywords

• Nosocomial infection
• hospital-acquired infection
• meningitis
• Enterobacteriaceae