Bacterial Meningitis In Infants Research Articles

Etiology of community-acquired bacterial meningitis in children at a tertiary-care centre in Montreal, Canada

Abstract Objectives This study aimed to identify the bacteria responsible for community-acquired bacterial meningitis in infants and children. Methods This was a retrospective cohort study including children aged 1 day to 18 years with confirmed bacterial meningitis, evaluated at a tertiary-care, Canadian emergency department between 2014 and 2022. The primary outcome was the pathogen identified. Other variables of interest were complications, age, and diagnostic method. Medical charts were reviewed by a co-investigator and 25% were assessed in duplicate. Results All 79 eligible cases were included. The main causal agents were Group B Streptococcus (GBS) (n = 20; 25%), Streptococcus pneumoniae (n = 16; 20%), Neisseria meningitidis (n = 16; 20%), and Haemophilus influenzae (n = 9; 11%). Etiology exhibited age-dependent variations, with 85% of GBS and 100% of Escherichia coli infections in children under 2 months. All pneumococcal and Group A Streptococcus cases were in children older than 6 months. All children infected by S. pneumoniae were vaccinated but the serotype was not covered by vaccination in 7/8 infections. All children with N. meningitidis were either too young to be vaccinated (n = 10) or infected by a serotype not covered by the given vaccine. Fifty-five bacteria were identified by cerebrospinal fluid culture, 17 by Polymerase Chain Reaction (PCR), and 7 by both methods. Conclusion GBS is now the leading etiology of paediatric community-acquired bacterial meningitis at our centre. The etiology of bacterial meningitis varies greatly by age. Future studies should focus on improving the serotype spectrum of vaccines, identifying strategies to lower GBS infection, and improving the use of PCR as a diagnostic tool.

Demographic and pathogen characteristics of incident bacterial meningitis in infants in South Africa: A cohort study.

Bacterial meningitis is a major cause of death, with an approximate case fatality rate of 37% across all age groups in South Africa. This study aimed to describe the demographic and pathogen characteristics of incident meningitis in children aged <1 year in South Africa from 2014 through 2018, during a period when Haemophilus influenzae type b vaccine and pneumococcal conjugate vaccines (PCV) were both included in the expanded program on immunization (EPI). We conducted a cohort study of routine laboratory data in the National Health Laboratory Service Corporate Data Warehouse, which covers approximately 80% of the South African population. We defined a case of laboratory-confirmed bacterial meningitis as any person aged <1 year with meningitis diagnosed by culture and identification of a pathogen documented as being a common cause of meningitis in CSF. The cause-specific incidence risks were calculated by dividing the number of positive specimens in each age group and year by the corresponding mid-year population for children under 1 year old and those in the post-neonatal period (≥ 28 days to 365 days old). For children under 28 days old, the annual numbers of registered livebirths were used. We used Poisson regression to compare the incidence of meningitis by year. We identified 3575 (1.5%) cases of culture-confirmed bacterial meningitis from the 232,016 cerebrospinal fluid (CSF) specimens tested from 2014-2018. The highest number of cases were recorded in children aged <28 days (1873, 52.4%), male children (1800, 50.4%) as well as in the Gauteng Province (2014, 56.3%). Acinetobacter baumannii (14.9%), followed by Klebsiella pneumoniae (13.5%), and group B streptococcus (GBS) (10.7%), were the most common pathogens detected. Overall, A. baumannii had the highest incidence risk, occurring at 9.8 per 100,000 persons in children aged <1 year in 2018. Among neonates, A. baumannii peaked at 14.9 per 100,000 livebirths in 2018, while Streptococcus pneumoniae was most common in the post-neonatal period (≥ 28 days to 365 days old), peaking at 9.8 per 100,000 persons in 2014. There was an increase in the annual incidence of most pathogens over the study period. There was an increasing trend in the annual incidence of bacterial meningitis in infants caused by most pathogens, particularly A. baumannii, K. pneumoniae and GBS. In addition to increased uptake of vaccination, prevention measures to reduce nosocomial and mother-to-child transmission of bacteria could include antenatal screening for GBS in pregnant women, rigorous hygiene in the hospital environment as well as rational antibiotic use.

Diagnostic Utility of Cerebrospinal Fluid White Blood Cell Components for the Identification of Bacterial Meningitis in Infants.

To evaluate the diagnostic and predictive utility of cerebrospinal fluid (CSF) white blood cell (WBC) components in the diagnosis of bacterial meningitis in infants discharged from the neonatal intensive care unit (NICU). We identified a cohort of infants discharged from a Pediatrix NICU between 1997 and 2020 who did not have an immunodeficiency, had at least 1 CSF culture collected within the first 120 days of life, and at least 1 CSF laboratory specimen obtained on the day of culture collection. We only included an infant's first CSF culture and excluded cultures from CSF reservoirs and those growing contaminants or nonbacterial organisms. We examined the utility of CSF WBC components to diagnose or predict bacterial meningitis by calculating sensitivity, specificity, positive and negative predictive values, likelihood ratios, and area under the receiver operating curve (AUC) at different cutoff values for each parameter. We performed subgroup analysis excluding infants treated with antibiotics the day before CSF culture collection. Of the 20 756 infants that met the study inclusion criteria, 320 (2%) were diagnosed with bacterial meningitis. We found (AUC [95% CI]) CSF WBC count (0.76 [0.73-0.79]), CSF neutrophil count (0.74 [0.70-0.78]), and CSF neutrophil percent (0.71 [0.67-0.75]) had the highest predictive values for bacterial meningitis, even when excluding infants with early antibiotic administration. No single clinical prediction rule had the optimal discriminatory power for predicting culture-proven bacterial meningitis, and clinicians should be cautious when interpreting CSF WBC parameters in infants with suspected meningitis.

Improved Diagnostics in Bacterial Neonatal Meningitis Using a Next-Generation Sequencing Platform.

Bacterial meningitis in infants is an infrequent but life-threatening condition. Empiric therapy should begin as soon as meningitis is thought likely. Consequently, the causative microorganisms may not always be detected using culturing techniques, as cerebrospinal fluid (CSF) cultures are influenced by antibiotics. Nucleic acid amplification tests, such as polymerase chain reaction (PCR) (multiplex panels), may overcome this limitation but require a priori knowledge of the likely pathogen present within the sample. With this in mind, we investigated to what extent a culture-free, broad-range 16S rRNA gene next-generation sequencing (NGS) platform (MYcrobiota) could add to the microbiological diagnosis of meningitis. Retrospective cohort study at level III neonatal intensive care unit. Included were all infants with suspected meningitis admitted between 10 November 2017 and 31 December 2020. A comparison was made of the bacterial pathogen detection rate between MYcrobiota and conventional bacterial culture. In a 3-year period, 37 CSF samples (diagnostic and follow-up) from 35 infants with proven or possible meningitis were available for MYcrobiota testing. MYcrobiota detected the presence of bacterial pathogens in 11 samples (30%), in contrast with the conventional CSF culture, which detected bacteria in 2 of 36 samples (5.6%). Addition of 16S rRNA sequencing to conventional culturing greatly improved the identification of the aetiology of bacterial meningitis compared to culturing of CSF samples alone.

Pneumococcal Meningitis with Serotype 7 Who Develops 12. Nerve Paralysis

Meningitis is an inflammatory disease of the leptomeninges surrounding the spinal cord and brain. Streptococcus pneumoniae (S. pneumoniae) is the most common cause of bacterial meningitis in infants and children older than one month. In this report, we present a 13-month-old infant who, after receiving three doses of the 13-valent conjugated pneumococcal vaccine, had nervus hypoglossus paralysis as a result of serotype 7 S. pneumoniae meningitis. She was admitted into our center with complaints of high fever for 2 days, apathy that started in the last 24 hours, and a tendency for sleeping. Penicillin and ceftriaxone susceptible S. pneumoniae grew in cerebrospinal fluid culture. Antibiotic treatment was completed in six weeks as she had a millimetric abscess in MR imaging. Considering common variable immunodeficiency in the patient who was examined for immunodeficiency, intravenous immunoglobulin treatment was started. The physical examination results of the patient were entirely improved. In conclusion, meningitis is a pediatric emergency with a high mortality and complication rate. If meningitis is managed on time and correctly it can heal without sequelae. Vaccination is crucial for prevention. Despite vaccination, although rare, infection with vaccine strains may occur. Patients infected with vaccine strains may require evaluation in terms of immunodeficiency.

Clinical Pharmacology of Gentamicin

Gentamicin is an important agent for the treatment of many serious gram-negative bacillary infections. Gentamicin is the aminoglycoside of first-choice because the reliable activity against all but the most resistant gram-negative aerobes. Gentamicin preparations are available for parenteral, ophthalmic, and topical administration. The recommended intramuscular or intravenous dose of gentamicin sulphate for treatment of gram-negative organisms in adults with normal renal function is 5 to 7 mg/kg daily. For patients with renal dysfunction the interval between may be extended. The efficacy and safety of gentamicin have been reported but gentamicin may induce nephrotoxicity and/or ototoxicity in some patients. Gentamicin penetrates in significant amounts into bone, skeletal muscle, wound tissue, ischemic foot ulcers, and in subcutaneous tissue. The pharmacokinetics of gentamicin have been studied in febrile neutropenic adult patients and in healthy adult subjects and gentamicin elimination half-life is about 3 hours. The pharmacokinetics of gentamicin have been investigated in tetraplegic and in paraplegic adult patients and in healthy adult subjects and the elimination half-life of gentamicin is about 2 hours. The prophylaxis, treatment, and trials with gentamicin have been extensively reported. Gentamicin penetrates into the cerebrospinal fluid in significant amounts and treats bacterial meningitis in infants. Gentamicin is poorly transferred across the human placenta and poorly migrates into the breast-milk. The aim of this study is to review gentamicin efficacy and safety, toxicity, diffusion into body-tissues, pharmacokinetics, prophylaxis, treatment, trials, penetration into the cerebrospinal fluid, treatment of bacterial meningitis, transfer across the human placenta, and migration into the breast-milk.

Salmonella typhimurium : A Rare Pathogen of Bacterial Meningitis in Infants, Not Associated With Household Contacts?

Salmonella typhimurium : A Rare Pathogen of Bacterial Meningitis in Infants, Not Associated With Household Contacts?

Salmonella Infantis Meningitis in a Pediatric Patient After in-Utero Exposure to Ustekinumab

Abstract Introduction/Objective Salmonella meningitis is associated with a significant neurological sequelae, subdural effusions, cerebral infarction, encephalitis, cerebral abscess, and high mortality. It is a rare complication of Salmonella sepsis and occurs almost exclusively during early infancy. Salmonella is identified as pathogen in less than 1% of confirmed cases of bacterial meningitis in infants. Immunocompromised individuals have higher risk of having invasive salmonellosis. Methods/Case Report We present a case of 4-month-old male with no significant past medical history who was presented to emergency department with five days history of fever, cough and decreased oral intake. At the time of admission, complete blood count was obtained and showed a platelet count of 702 x 10(3)/mcL, hematocrit of 25% and WBC of 17.0 x 10(3)/mcL with differential showing absolute neutrophilia and absolute monocytosis. Head ultrasound was concerning for meningoencephalitis with bilateral parenchymal echogenicity and bilateral subdural collections. Lumbar puncture showed WBC cell count of 229 (36 % PMNs, 52% lymphocytes, 12% monocytes), red blood cells of 0, glucose of 13 mg/dL, protein of 151 mg/dL. Meningitis multiplex PCR panel of the CSF was negative. MRI of the brain showed findings suggestive of meningitis with associated subdural empyema and ventriculitis without hydrocephalus. CSF culture identified Salmonella species that is susceptible to ampicillin and ceftriaxone which later identified as Salmonella infantis by the State laboratory. Immunodeficiency workup including next generation sequencing immunodeficiency panel did not reveal any known causes. Of note, mother has psoriasis and was treated with ustekinumab; an antibody against a cytokine subunit shared by IL12 and IL23, during pregnancy. The patient responded to antibiotic treatment and was discharged in a stable condition. Results (if a Case Study enter NA) N/A. Conclusion This case report highlights Salmonella infantis meningitis in a pediatric patient who was exposed to ustekinumab in utero which could cause drug induced immunodeficiency state as IL-12 is known to activate macrophages and macrophages are critical for Salmonella clearance. Although ustekinumab level was undetected in the patient right prior to discharge, the long half-life and mechanism of action of this medication could have caused an immunodeficiency state which allowed rare Salmonella infantis meningitis.

Can Duration of Antibiotic Therapy for Bacterial Meningitis in Infants Be Shortened?

Can Duration of Antibiotic Therapy for Bacterial Meningitis in Infants Be Shortened?

Serious Bacterial Infections in Young Febrile Infants With Positive Urinalysis Results.

To determine the prevalence of bacteremia and/or bacterial meningitis in febrile infants ≤60 days of age with positive urinalysis (UA) results. Secondary analysis of a prospective observational study of noncritical febrile infants ≤60 days between 2011 and 2019 conducted in the Pediatric Emergency Care Applied Research Network emergency departments. Participants had temperatures ≥38°C and were evaluated with blood cultures and had UAs available for analysis. We report the prevalence of bacteremia and bacterial meningitis in those with and without positive UA results. Among 7180 infants, 1090 (15.2%) had positive UA results. The risk of bacteremia was higher in those with positive versus negative UA results (63/1090 [5.8%] vs 69/6090 [1.1%], difference 4.7% [3.3% to 6.1%]). There was no difference in the prevalence of bacterial meningitis in infants ≤28 days of age with positive versus negative UA results (∼1% in both groups). However, among 697 infants aged 29 to 60 days with positive UA results, there were no cases of bacterial meningitis in comparison to 9 of 4153 with negative UA results (0.2%, difference -0.2% [-0.4% to -0.1%]). In addition, there were no cases of bacteremia and/or bacterial meningitis in the 148 infants ≤60 days of age with positive UA results who had the Pediatric Emergency Care Applied Research Network low-risk blood thresholds of absolute neutrophil count <4 × 103 cells/mm3 and procalcitonin <0.5 ng/mL. Among noncritical febrile infants ≤60 days of age with positive UA results, there were no cases of bacterial meningitis in those aged 29 to 60 days and no cases of bacteremia and/or bacterial meningitis in any low-risk infants based on low-risk blood thresholds in both months of life. These findings can guide lumbar puncture use and other clinical decision making.

Laboratory finding of CSF analysis in patients with meningitis at Elamin Hamid Pediatrics Hospital in Khartoum, Sudan

Bacterial meningitis in infants and children is a serious clinical entity with signs and symptoms that commonly do not allow distinguishing the diagnosis and the causative agents. The only method to determine if meningitis is the cause of these symptoms is a lumbar puncture. Lumbar puncture is the gold standard for the diagnosis and should be done in all suspected cases of meningitis unless contraindicated. Objectives: The purpose of this study is to identify the importance of the microbiological study of cerebrospinal fluid (CSF) in patients suspected to have acute meningitis. Despite the availability of all other investigations and Imaging for diagnosis of meningitis but CSF analysis remains the most available, accurate, and cheaper for diagnosis of meningitis in children. Methodology and result: This is a prospective study. 71 patients were included. All patients were clinically suspected to have acute meningitis. A lumbar puncture for CSF analysis was done for all patients. The data was collected and analysed. CSF culture was done. The culture was negative In 58 patients (81.7%) and positive in 13 patients (18.3%). Streptococcus was found in 3 patients (4.2 %), staphylococcus epidermidis in 2 patients (2.8%), E Coli in 2 patients (2.8%), klebsiella in 2 patients (2.8%), pneumococci in 2 patient (2.8%), salmonella in 1 patient (1,4%) and Bacilli in 1 patient (1.4 %). Recommendation: Lumbar Puncture (LP) remains the easiest, cheapest and accurate investigation for diagnosis of meningitis in children mainly in rural areas in Sudan and other developing countries. It’s mandatory to offer training for doctors and medical staff for doing lumber punctures safely and accurately and to offer well-equipped laboratories for such essential investigations. It’s not only the role of doctors and medical staff but is a governmental obligation as well. This can save a lot of sick children and prevent mortality and morbidity of acute meningitis in children.

Acute Bacterial Meningitis in Infants and Children

A study of acute bacterial meningitis in infants and children had been reported. Of particular interest in this study was the fact that the results of the CSF cultures revealed the most frequent causative agent to be Diplococcus pneumoniae (35%), with Staphylococcus aureus ranking second (25%). Other causative agents were E. coli (10%), Salmonella paratyphi B (10%), Streptococus pyogenes (5%). Hemophilus influenzae was not found in this study. The mortality rate was 40%.

1148. Duration of Antibiotic Therapy in the Treatment of Bacterial Meningitis in Young Infants: A Systematic Review and Narrative Synthesis

BackgroundIDSA recommendations of 14-21 days of parenteral therapy for bacterial meningitis are based predominantly on expert consensus. Parenteral durations consistent with these recommendations are sometimes provided even when meningitis is suspected but not confirmed. We aimed to systematically review the literature on duration of parenteral antibiotic therapy and outcomes in bacterial meningitis in infants < 3 months of age.MethodsWe searched PubMed, Embase, and the Cochrane Central Register of Controlled Trials for publications up until May 11, 2021. Eligible studies were published in English and included infants < 3 months of age with bacterial meningitis for which route and duration of antibiotic therapy and outcomes were reported. We excluded case reports and infants with birth weight < 1500g, major congenital malformations, or neurosurgical conditions. We assessed bias using published tools specific to study type. A meta-analysis was not conducted due to insufficient data on outcomes by duration of therapy. PROSPERO registration: CRD42020201667.ResultsA total of 2195 studies were identified; 280 were selected for full text review and 32 were included for narrative synthesis. There was 1 randomized-controlled trial (RCT), 25 cohort studies, and 6 case series. The RCT found no difference in treatment failure rates between 10 and 14 days of therapy, but only included 2 cerebrospinal fluid (CSF) culture-positive cases. A single cohort study including only CSF culture-negative cases presented outcomes by duration of therapy and concluded that courses >21 days had no impact on prognosis. Twenty-one studies had data on duration of therapy and outcomes by patient, most with small samples (median 4 patients). No conclusions on efficacy of shortened antibiotic courses could be drawn due to small sample sizes and lack of stratification of outcomes by short versus long courses.ConclusionData on parenteral treatment duration in bacterial meningitis in infants < 3 months are primarily observational, and larger studies rarely report outcomes by duration of therapy. Given the associated risks and costs of prolonged parenteral therapy, there is a pressing need for comparative effectiveness research to determine the optimal parenteral treatment duration.Disclosures All Authors: No reported disclosures

Accuracy of Clinical and Cerebrospinal Fluid Indicators in the Diagnosis of Bacterial Meningitis in Infants

The diagnosis of bacterial meningitis (BM) is problematic in young infants, as clinical features may be nonspecific or even absent. Cerebrospinal fluid (CSF) analysis usually confirms the diagnosis, but the CSF parameters can be normal also in culture-proven BM. Our objective was to identify the clinical and CSF indices, that quickly and without laboratory likely lead to the diagnosis of confirmed of probable BM in young infants in Angola. We conducted a prospective, observational, single-site study from February 2016 to October 2017 in the Pediatric Hospital of Luanda. All assessed infants showed symptoms and signs compatible of BM or neonatal sepsis and were <90 days of age. Of the 1088 infants, 212 (19%) showed bacteria in CSF, while 88 (8%) had probable BM. Independent clinical indicators of BM were not-clear CSF, seizures, weight <2500 g and illness >7 days. In infants with BM, CSF leukocytes were >10 × 106/L in 46%, CSF glucose <25 mg/dL in 43% and CSF protein >120 mg/dL in 58%. All measured parameters were in normal range in 25% of patients. In 515 infants with normal CSF parameters, bacteria were found in 74 (14%). In these infants, illness >7 days, weight <2500 g and malnutrition increased the probability of BM. Our study confirms and underlines the problems in diagnosing BM in young infants. While the CSF parameters were normal in 25% of infants, the easily recognizable unclear appearance of CSF was the single strongest predictor of BM.

Risk factors for death in suspected severe bacterial infection in infants aged

BackgroundYearly, about two million infants die during the first 28 days of life. Most of these deaths occur in sub-Saharan Africa and a third of those are caused by severe infections. The early identification of infants at risk of death is important when trying to prevent poor outcomes. ObjectiveThe aim of this study was to identify risk factors for death among young infants with possible serious bacterial infection (pSBI) at hospital admission. MethodsThis prospective, observational, single-site, descriptive study forms part of a larger study on bacterial meningitis in infants <90 days of age admitted to the Pediatric Hospital of Luanda, the capital of Angola, from February 1, 2016 to October 23, 2017. Infants with pSBI, a known outcome, and a final diagnosis were included. ResultsOf 574 young infants with pSBI, 115 (20%) died in hospital. An altered level of consciousness, absence of spontaneous movements, dyspnea, CSF that is not clear, low CSF glucose, high CSF protein, heart rate over the median, and seizures were identified as risk factors for death in the univariate analysis. In the multivariate analysis, only heart rate over the median and seizures were independent predictors of death. ConclusionsEasily recognizable clinical signs – tachycardia and seizures – may guide clinicians to identify infants at high risk of death due to severe bacterial infections in sub-Saharan Africa.

Predictive value of repeated cerebrospinal fluid parameters in the outcomes of bacterial meningitis in infants

BackgroundThere are variations in recommendations from different guidelines regarding the indications for repeat lumbar puncture (LP) in young infants with the diagnosis of bacterial meningitis.ObjectiveTo evaluate the frequency of repeat LPs and the characteristics of cerebrospinal fluid (CSF) parameters in repeated sampling and their predictive values for adverse outcomes in a national cohort.MethodsThis cohort study included infants born January 1, 2013 through December 31, 2014, who had proven or suspected bacterial meningitis within the first 90 days of life at seven paediatric tertiary care hospitals across Canada, and who underwent a repeat LP at the discretion of the treating physicians.ResultsForty-nine of 111 infants (44%) underwent repeat LP at a median of 5 (IQR: 3, 13) days after the LP that led to the diagnosis of bacterial meningitis. Those who had meningitis caused by gram negative bacilli were more likely to have repeat LP than those with gram positive bacteria (77% versus 57%; p = 0.012). White blood cell (WBC) count on the second spinal tap yielded an area under the curve of 0.88 for predicting sequelae of meningitis at discharge from the hospital, with a cut-off value of 366 × 106/L, providing a sensitivity of 91% and specificity of 88%.ConclusionIn this multi-centre retrospective cohort study, infants with gram negative meningitis were more likely to have repeated LP. A high WBC on the second CSF sample was predictive of adverse outcome at the time of discharge from the hospital.

Aetiology of bacterial meningitis in infants aged

BackgroundDespite effective antibiotics and vaccines, bacterial meningitis (BM) remains one of the leading causes of morbidity and mortality in young infants worldwide. Data from Africa on the aetiology and antibiotic susceptibility are scarce. ObjectiveTo describe the aetiology of BM in Angolan infants <90 days of age. MethodsA prospective, observational, single-site study was conducted from February 2016 to October 2017 in the Paediatric Hospital of Luanda. All cerebrospinal fluid samples (CSF) from infants aged <90 days with suspected BM or neonatal sepsis were assessed. The local laboratory performed microscopy, chemistry, culture, and susceptibility testing. PCR for vaccine-preventable pathogens was performed in Johannesburg, South Africa. ResultsOf the 1287 infants, 299 (23%) had confirmed or probable BM. Of the 212 (16%) identified bacterial isolates from CSF, the most common were Klebsiella spp (30 cases), Streptococcus pneumoniae (29 cases), Streptococcus agalactiae (20 cases), Escherichia coli (17 cases), and Staphylococcus aureus (11 cases). A fifth of pneumococci (3/14; 21%) showed decreased susceptibility to penicillin, whereas methicillin-resistant S. aureus (MRSA) was encountered in 4/11 cases (36%). Of the gram-negative isolates, 6/45 (13%) were resistant to gentamicin and 20/58 (34%) were resistant to third-generation cephalosporins. Twenty-four percent (33/135) of the BM cases were fatal, but this is likely an underestimation. ConclusionsBM was common among infants <90 days of age in Luanda. Gram-negative bacteria were predominant and were often resistant to commonly used antibiotics. Continued surveillance of the antibiogram is pivotal to detect potential changes without delay.

Derivation of a metabolic signature associated with bacterial meningitis in infants.

Background:Diagnosis of bacterial meningitis (BM) is challenging in newborn infants. Presently, biomarkers of BM have limited diagnostic accuracy. Analysis of cerebrospinal fluid (CSF) metabolites may be a useful diagnostic tool in BM.Methods:In a nested case-control study, we examined over 400 metabolites in CSF of uninfected infants and infants with culture-confirmed BM using gas- and liquid-chromatography mass spectrometry. Preterm and full-term infants in a Level III or IV Neonatal Intensive Care Unit were prospectively enrolled when evaluated for serious bacterial infection.Results:Over 200 CSF metabolites significantly differed in uninfected infants and infants with BM. Using machine-learning, we found as few as 6 metabolites distinguished infants with BM from uninfected infants in this pilot cohort. Further analysis demonstrated 3 metabolites associated with Group B Streptococcal meningitis.Conclusions:We report the first comprehensive metabolic analysis of CSF in infants with BM. In our pilot cohort, we derived a metabolic signature that predicted the presence or absence of BM, irrespective of gestational age, postnatal age, sex, race and ethnicity, presence of neurosurgical hardware, white blood cell count in CSF, and red blood cell contamination in CSF. Metabolic analysis may aid diagnosis of BM and facilitate clinical decision-making in infants.

Risk factor for hearing loss from acute bacterial meningitis in infant

Risk factor for hearing loss from acute bacterial meningitis in infant

Testing for Meningitis in Febrile Well-Appearing Young Infants With a Positive Urinalysis.

To determine factors associated with cerebrospinal fluid (CSF) testing in febrile young infants with a positive urinalysis and assess the probability of delayed diagnosis of bacterial meningitis in infants treated for urinary tract infection (UTI) without CSF testing. We performed a retrospective cohort study using data from the Reducing Excessive Variability in Infant Sepsis Evaluation quality improvement project. A total of 20 570 well-appearing febrile infants 7 to 60 days old presenting to 124 hospitals from 2015 to 2017 were included. A mixed-effects logistic regression was conducted to determine factors associated with CSF testing. Delayed meningitis was defined as a new diagnosis of bacterial meningitis within 7 days of discharge. Overall, 3572 infants had a positive urinalysis; 2511 (70.3%) underwent CSF testing. There was wide variation by site, with CSF testing rates ranging from 64% to 100% for infants 7 to 30 days old and 10% to 100% for infants 31 to 60 days old. Factors associated with CSF testing included: age 7 to 30 days (adjusted odds ratio [aOR]: 4.6; 95% confidence interval [CI]: 3.8-5.5), abnormal inflammatory markers (aOR: 2.2; 95% CI: 1.8-2.5), and site volume >300 febrile infants per year (aOR: 1.8; 95% CI: 1.2-2.6). Among 505 infants treated for UTI without CSF testing, there were 0 (95% CI: 0%-0.6%) cases of delayed meningitis. There was wide variation in CSF testing in febrile infants with a positive urinalysis. Among infants treated for UTI without CSF testing (mostly 31 to 60-day-old infants), there were no cases of delayed meningitis within 7 days of discharge, suggesting that routine CSF testing of infants 31 to 60 days old with a positive urinalysis may not be necessary.