Refractory Purulent Meningitis Caused by Extended-Spectrum Beta-Lactamase-Producing Escherichia coli Complicated by Supraspinal Neurogenic Bladder in an Infant

Purulent meningitis is a severe central nervous system (CNS) infection in early infancy associated with high morbidity and long-term neurological sequelae. While neurogenic bladder secondary to purulent meningitis has been reported in adults, this complication is rarely described in pediatric survivors. We present a 2-month-old male infant with refractory meningitis caused by extended-spectrum beta-lactamase-producing Escherichia coli (ESBL-EC), complicated by subdural effusions, septic shock, and subsequent supraspinal-origin neurogenic bladder. Despite 21 days of intravenous meropenem therapy, the patient had persistently abnormal cerebrospinal fluid (CSF) parameters and recurrent fever, requiring intermittent dexamethasone and neurosurgical subdural drainage. Serial neuroimaging revealed bilateral frontotemporal cortical softening and hemorrhage. At 4-month follow-up, urological evaluation demonstrated reduced bladder compliance, detrusor overactivity, elevated post-void residual volume, and grade-III left vesicoureteral reflux. Normal spinal magnetic resonance imaging (MRI) localized injury to supraspinal micturition centers. Clean intermittent catheterization and antibiotic prophylaxis were initiated. Nevertheless, recurrent febrile urinary tract infections (UTIs) and progressive growth deceleration persisted up to 12 months of age. This case demonstrates that refractory infantile purulent meningitis with cortical brain injury may trigger neurogenic bladder. Early recognition, multidisciplinary teamwork, and long-term urological surveillance are critical for affected children. Further research is required to optimize antibiotic and corticosteroid regimens for complicated pediatric CNS infections.