Healthcare-associated post-neurosurgical meningitis caused by extended-spectrum beta-lactamase-producing Klebsiella pneumoniae in an Infant: A case report.

Healthcare-associated meningitis caused by extended-spectrum β-lactamase (ESBL)-producing Klebsiella pneumoniae is a well-recognized condition after neurosurgical procedures in adults; however, it remains uncommon in children, particularly when detailed microbiological characterization is available. Here we report a case of ESBL-producing K. pneumoniae meningitis with hypervirulent features following neurosurgical intervention in an infant. A previously healthy male infant developed fever and seizures on day of life 58, 2 days after external ventricular drain (EVD) placement and tumor resection. Cerebrospinal fluid (CSF) analysis revealed pleocytosis and gram-negative bacilli. Intravenous meropenem was initiated, and EVD was removed. Cultures from CSF and the catheter yielded ESBL-producing K. pneumoniae (ST37) harboring blaCTX-M-15, blaSHV-11, and blaTEM-1. The isolate demonstrated hypermucoviscosity and carried virulence-associated genes. CSF sterilization was achieved within 5 days; however, the clinical course was complicated by cranial nerve deficits. The patient completed 8 weeks of therapy and was discharged with persistent neurological sequelae. The findings from this case suggest that ESBL-producing Gram-negative bacilli should be considered for infants with post-neurosurgical meningitis when risk factors such as EVD placement, CSF leakage, and healthcare exposure are present. Prompt source control and empiric antimicrobial therapy guided by local resistance epidemiology are critical. Although resistance and virulence-associated traits were identified in our case, their contribution to the neurological sequelae remains uncertain.