Double infection by Multi-Drug Resistant Escherichia coli bacteria: A case report

Introduction: Antimicrobial resistance (AMR) is a global issue causing multidrug
resistant bacterial infections, leading to higher morbidity and mortality rates.
Escherichia coli, a Gram-negative Enterobacterales bacteria, is the predominant cause
of common diseases. In 2018, Escherichia coli ESBL (beta-lactamase enzyme
Extended-spectrum) bacterium had the highest antibiotic resistance in Surabaya,
Indonesia. In 2022, 3rd generation cephalosporin-resistant E. coli and carbapenem
resistant E. coli were the top priority pathogens in Indonesia.
Case: A one-year-old girl was taken to the emergency room after vomiting seven times
and vomiting. She had a fever for one week, and her nose was runny. The patient had
kidney channels narrowed and had surgery to implant a DJ stent in her right kidney five
months prior. Physical examination revealed anemia, jaundice, cyanosis, and dyspnea.
Blood and urine cultures were conducted, and Escherichia coli bacteria were found in
urine and blood samples. Escherichia coli ESBL was found to be sensitive to several
drugs, while its blood showed it was carbapenem-resistant, only sensitive to
Ceftazidim, Amikacin, Gentamicin, Tigecycline, and Cefoperazone Sulbactam.
Discussion: Pediatric patients often experience urinary infections from Escherichia coli
(ESBL) and bloodstream infections from Escherichia coli (CRE). These bacteria
colonize various sites in the human body, including the urinary tract, causing diarrhea
and causing cystitis. ESBL, or Extended Spectrum b-lactamase, breaks down
antibiotics, making them ineffective for treating infections. ESBL production is
associated with a bacterium found in the bowel, and resistance genes are often
transmitted through plasmids carrying other resistance genes. The emergence of
carbapenem-resistant Escherichia coli isolates (CREC) has led to using polymyxin,
tigecycline, fosfomycin, and aminoglycosides as effective antibiotics against CREC.
CREC can lead to severe infections, including intra-abdominal infections, pneumonia,
urinary tract infections, and device-associated infections.
Conclusions:
Escherichia coli, an MDRO bacteria, requires antibiotic sensitivity test results for
effective treatment, with sensitive drugs often chosen in difficult cases, and requiring
source control.