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Escherichia (E.) coli is a Gram-negative, facultative anaerobic, rod-shaped, coliform bacterium of the genus Escherichia that is commonly found in the lower intestine of warm-blooded organisms . E. coli is an important pathogen implicated in pediatric bacterial meningitis, especially in neonates , but it is an uncommon pathogen of adult bacterial meningitis (ABM) [3-5]. In 2005, we reported a brief analysis of E. coli ABM . In recent years, except for a study reported by Bichon et al.  who described two spontaneous cases of community-acquired E. coli ABM and performed a literature review, no other study has focused on this specific infectious syndrome. Therefore, in this study we analyzed the clinical characteristics, laboratory data and therapeutic outcomes of 25 adult patients with E. coli ABM, and we also reviewed the literature in order to better delineate the clinical features of this specific infectious syndrome.