A Rare Intruder: Neonatal Meningoencephalitis by Edwardsiella tarda Requiring Systemic and Intrathecal Antibiotics and Repeated Neurosurgery

<b>Background/Objectives</b>: <i>Edwardsiella tarda</i> is a rare Gram-negative pathogen that uncommonly infects humans. Neonatal infections are extremely rare but often severe, with a high incidence of central nervous system (CNS) complications. <b>Case presentation</b>: We report a term neonate born via spontaneous vaginal delivery who developed systemic signs of infection within 18 h of life. Blood and cerebrospinal fluid (CSF) cultures grew <i>Edwardsiella tarda</i>. CSF analysis revealed severe meningoencephalitis. Maternal stool culture was also positive for <i>E. tarda</i>, suggesting vertical transmission. Despite initial systemic antibiotic therapy with ampicillin, gentamicin, and ceftriaxone, neuroimaging revealed progressive multifocal brain abscesses. The infant underwent a series of neurosurgical procedures, including bilateral drainage of abscesses, Rickham reservoir placement and ventriculoperitoneal shunting. A revised antibiotic regimen, including systemic meropenem and trimethoprim-sulfamethoxazole plus intrathecal gentamicin, was administered. At six months, the infant showed mild motor delay with lower limb hypertonia and was under close neurosurgical and developmental follow-up. <b>Methods</b>: We conducted a literature review of 12 published neonatal <i>E. tarda</i> infections, including our case. <b>Results</b>: Most infected infants presented within 72 h of life and exhibited CNS involvement. Mortality was 25%, and 44% of survivors experienced long-term neurologic sequelae. <b>Conclusions</b>: <i>Edwardsiella tarda</i> infection in neonates is rare but potentially devastating. Early suspicion, culture confirmation, aggressive antibiotic therapy, and multidisciplinary care, including neurosurgical management, are essential for improving outcomes.