The Epidemiology of Meningitis in Infants under 90 Days of Age in a Large Pediatric Hospital.

Timothy A Erickson,Melissa S Nolan,Catherine L Troisi,Eric L Brown,Flor M Munoz,Rodrigo Hasbun,Kristy O Murray

doi:10.3390/microorganisms9030526

Abstract

Background: Meningitis is associated with substantial morbidity and mortality, particularly in the first three months of life. Methods: We conducted a retrospective review of patients <90 days of age with meningitis at Texas Children’s Hospital from 2010–2017. Cases were confirmed using the National Healthcare Safety Network (NHSN) definition of meningitis. Results: Among 694 infants with meningitis, the most common etiology was viral (n = 351; 51%), primarily caused by enterovirus (n = 332; 95%). A quarter of cases were caused by bacterial infections (n = 190; 27%). The most common cause of bacterial meningitis was group B Streptococcus (GBS, n = 60; 32%), followed by Gram-negative rods other than E. coli (n = 40; 21%), and E. coli (n = 37; 19%). The majority of Gram-negative organisms (63%) were resistant to ampicillin, and nearly one-fourth of Gram-negative rods (23%) other than E. coli and 2 (6%) E. coli isolates were resistant to third-generation cephalosporins. Significant risk factors for bacterial meningitis were early preterm birth and the Black race. Conclusions: Enteroviruses most commonly caused viral meningitis in infants; GBS was the most common bacterial cause despite universal screening and intrapartum prophylaxis. The emergence of MRSA and resistance to third-generation cephalosporins in Gram-negative bacterial meningitis challenges the options for empirical antimicrobial therapy.

Highlights

Meningitis is associated with substantial morbidity and mortality, in infants
Network (NHSN) definition of meningitis, which states that a case of meningitis requires having either (1) an organism identified from the cerebrospinal fluid (CSF) by culture, PCR, or confirmatory level of IgM, OR (2) CSF pleocytosis and compatible signs and symptoms [14,15]
If a patient with pleocytosis and clinically compatible signs and symptoms had no organism identified in the CSF but had an organism isolated from a different sterile site that is a known cause of meningitis, they were classified as meningitis caused by that organism

Summary

Introduction

Meningitis is associated with substantial morbidity and mortality, in infants. Numerous causes of meningitis exist, with viral and bacterial infectious agents the most common. About one-quarter of the cases of meningitis lacks an identified cause [1]. Infants, those under 90 days of age, historically have the highest attack rates for bacterial meningitis, with Haemophilus influenzae type b (Hib) being most common in the era prior to routine vaccination and group B Streptococcus (GBS) and E. coli most commonly reported since. Other leading causes include viral infection with enterovirus and herpes simplex virus (HSV) [2,3,4,5,6,7,8,9]. A few studies have investigated the epidemiology of infant meningitis since the introduction of antenatal screening and antepartum treatment for GBS in pregnant women and the advent of molecular diagnosis [7,8,10,11]

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Results

Conclusion