日本新生児成育医学会雑誌　37(1)：115-121；2025　

日本新生児成育医学会雑誌　第37巻　第1号　115 ～ 121頁（2025年）

受付日：2024．06．07

受理日：2024．09．09

初期評価の髄液検査で診断に至らなかった基質特異拡張型ベータラクタマーゼ産生大腸菌性髄膜炎の新生児

Bacterial Meningitis in a Neonate Caused by Extended-Spectrum β-lactamase-producing Escherichia coli Undiagnosed at Initial Cerebrospinal Fluid Evaluation

＊ 1 公立豊岡病院組合立豊岡病院　小児科，＊ 2 兵庫県立こども病院　感染症内科，＊ 3 鹿児島大学大学院　医歯学総合研究科　微生物学分野

＊ 1 Department of Pediatrics, Toyooka Public Hospital， ＊ 2 Division of Infectious Disease, Department of Pediatrics, Hyogo Prefectural Kobe Children’s Hospital， ＊ 3 Department of Microbiology, Graduate School of Medical and Dental Sciences, Kagoshima University

竹本崇之＊ 1・山田博之＊ 1・上田雅章＊ 1・藤林洋美＊ 1・笠井正志＊ 2・藺牟田直子＊ 3・西　順一郎＊ 3・港　敏則＊ 1

Takayuki TAKEMOTO ＊ 1，Hiroyuki YAMADA ＊ 1，Masaaki UEDA ＊ 1，Hiromi FUJIBAYASHI ＊ 1， Masashi KASAI ＊ 2，Naoko IMUTA ＊ 3，Junichiro NISHI ＊ 3，Toshinori MINATO ＊ 1

Key Words：bacterial meningitis，Escherichia coli，extended-spectrum β-lactamase，relapsed meningitis

症例は在胎39 週3 日，体重2,830g で出生した女児で，日齢1 に早発型感染症と診断し，アンピシリンおよびセ フォタキシム投与を開始した。抗菌薬投与30 分後の髄液検査では，髄液所見は正常であった。血液培養から基質特 異拡張型ベータラクタマーゼ（extended-spectrum β-lactamase：ESBL）産生大腸菌が分離されたため，日齢2 に 抗菌薬をメロペネムに変更した。日齢4 に再発熱し，左方移動を伴う白血球増加を認めたが，日齢8 に解熱し，菌 血症として治療を終了した。しかし治療終了から4 日後に再発熱し，ESBL 産生大腸菌性髄膜炎と診断した。適切 な抗菌薬投与が遅れたため，初期評価の髄液検査後に発症した髄膜炎の再燃例と考えた。菌血症治療中の再発熱や 白血球増加は全身状態の改善と矛盾する所見であり，適切な抗菌薬投与に時間を要した経過を考慮すると，髄膜炎 の可能性を疑う契機になりえた。髄液検査再検を行うことで，より早期に髄膜炎を診断しえた可能性が考えられた。

A female neonate, born at 39 weeks and 3 days of gestational age with a birth weight of 2,830 g, was diagnosed with early- onset neonatal sepsis. She was treated with ampicillin and cefotaxime at 1 day old. Cerebrospinal fluid （CSF） assay performed 30 minutes after antibiotics administration revealed normal results. Extended-spectrum β-lactamase（ ESBL） -producing Escherichia coli was isolated from blood culture；thus, antibiotics were switched to meropenem at 2 days old. Recurrent fever and leukocytosis accompanied with left shift were observed from 4 to 8 days old, after which the antibiotic therapy for bacteremia was completed. The patient developed a recurrent fever 4 days after the secession of antibiotic administration and was diagnosed with bacterial meningitis. Relapsed meningitis, which might have developed after the initial CSF examination, was suspected due to the delay in administration of appropriate antibiotics. Recurrent fever and leukocytosis accompanied with left shift during antibiotic therapy contradicted with the improvement in general conditions. Therefore, these findings might have been a clue for suspecting bacterial meningitis, considering the delay in administration of appropriate antibiotics. Furthermore, an early diagnosis of bacterial meningitis could have been achieved through CSF re-examination.