Korean J Lab Med.  2007 Feb;27(1):46-49. 10.3343/kjlm.2007.27.1.46.

A Case of Erythromycin-Resistant Ureaplasma urealyticum Meningitis in a Premature Infant

• Chung HY
• Chung JW
• Chun SH
• Sung HS
• Kim MN
• Kim KS

• KMID: 1121659
• DOI: http://doi.org/10.3343/kjlm.2007.27.1.46

Abstract

Ureaplasma urealyticum causes infection or colonization of female genital tracts associated with preterm delivery and infertility and the infection of the bloodstream, respiratory tract, and central nervous system in infants, especially in prematures. We report the first case of U. urealyticum meningitis in a premature infant in Korea. She was born with a birth weight of 1,481 gram at 32+3 weeks' gestation and hospitalized for a respiratory care in the NICU in November 2005. Endotracheal aspirates and urine cultures grew U. urealyticum at <10(4) CFU/mL of the specimens at 2-day-old, and cerebrospinal fluid (CSF) cultures grew U. urealyticum at > or = 10(4) CFU/mL of CSF. The patient had a marked CSF pleocytosis, low glucose and high protein content on the 13th hospital day. CSF cultures for ordinary bacteria, mycobacteria and fungi remained negative. U. urealyticum was resistant to erythromycin, tetracycline, ciprofloxacin and pristinamycin, but susceptible to doxycycline. Although she was treated with erythromycin for 30 days, the organism was still isolated four times from the CSF with fluctuation of C-reactive protein (CRP). After the addition of chloramphenicol, CSF cultures became negative in 3 days. However, CRP rose again with increased BUN at the 99th hospital day, and she died on the 103rd hospital day under the diagnosis of a clinical sepsis of unknown origin. In acute meningitis of prematures already colonized with U. urealyticum, ureaplasmal cultures and susceptibility test are warranted in Korea.

Keyword

Ureaplasma urealyticum; Meningitis; Premature infant

MeSH Terms

Anti-Bacterial Agents/*therapeutic use
Drug Resistance, Bacterial
Erythromycin/*therapeutic use
Humans
Infant, Newborn
Infant, Premature
Infant, Premature, Diseases/*diagnosis/drug therapy
Meningitis, Bacterial/*diagnosis/drug therapy
Ureaplasma Infections/*diagnosis/drug therapy
*Ureaplasma urealyticum

Figure

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  Fig. 1. Flowchart of C-reactive protein (CRP) with the results of mycoplasma culture and the course of antimicrobial therapy. Abbreviations: ↓ culture positive; ↓ culture negative; E, endotracheal aspirate; C, cerebrospinal fluid; U, urine; VAN, vancomycin; AMK, amikacin; EM, erythromycin; CHL, chloramphenicol.

Reference

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