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The Epidemiology, Management, and Outcomes of Bacterial Meningitis in Infants
Lynda Ouchenir1, Christian Renaud1, Sarah Khan2
1Centre hospitalier universitaire Sainte-Justine, University of Montreal, Montreal, Quebec, Canada.
Insights
Empirical antibiotics for infant bacterial meningitis should target common pathogens like E. coli and GBS. Consider third-generation cephalosporins, with ampicillin for newborns, and carbapenems for Gram-negative infections.
Area of Science:
- Pediatric Infectious Diseases
- Neonatal Care
- Antimicrobial Stewardship
Background:
- Bacterial meningitis in infants under 90 days presents evolving challenges due to antimicrobial resistance, vaccination, and maternal antibiotic use.
- Group B Streptococcus (GBS) and Escherichia coli are significant pathogens in early infancy.
Purpose of the Study:
- To determine optimal empirical antibiotic strategies for bacterial meningitis in neonates and young infants.
- To assess current pathogen prevalence and antimicrobial susceptibilities in infant meningitis.
Main Methods:
- A cohort study involving 113 infants (<90 days) with bacterial meningitis across 7 Canadian pediatric tertiary care hospitals (2013-2014).
- Data collected on pathogen identification, antimicrobial resistance, and clinical outcomes.
Main Results:
- Escherichia coli (33%) and GBS (31%) were the predominant pathogens.
- Some isolates showed resistance to common empirical treatments, including ampicillin and gentamicin.
- Cefotaxime was not ideal for certain Gram-negative organisms like Listeria monocytogenes.
Conclusions:
- E. coli and GBS remain leading causes of infant meningitis.
- Recommended empirical therapy includes third-generation cephalosporins plus ampicillin for the first month.
- Carbapenems may be necessary for Gram-negative meningitis cases.
Objectives:
The pathogens that cause bacterial meningitis in infants and their antimicrobial susceptibilities may have changed in this era of increasing antimicrobial resistance, use of conjugated vaccines, and maternal antibiotic prophylaxis for group B Streptococcus (GBS). The objective was to determine the optimal empirical antibiotics for bacterial meningitis in early infancy.
Methods:
This was a cohort study of infants <90 days of age with bacterial meningitis at 7 pediatric tertiary care hospitals across Canada in 2013 and 2014.
Results:
There were 113 patients diagnosed with proven meningitis (n = 63) or suspected meningitis (n = 50) presented at median 19 days of age, with 63 patients (56%) presenting a diagnosis from home. Predominant pathogens were Escherichia coli (n = 37; 33%) and GBS (n = 35; 31%). Two of 15 patients presenting meningitis on day 0 to 6 had isolates resistant to both ampicillin and gentamicin (E coli and Haemophilus influenzae type B). Six of 60 infants presenting a diagnosis of meningitis from home from day 7 to 90 had isolates, for which cefotaxime would be a poor choice (Listeria monocytogenes [n = 3], Enterobacter cloacae, Cronobacter sakazakii, and Pseudomonas stutzeri). Sequelae were documented in 84 infants (74%), including 8 deaths (7%).
Conclusions:
E coli and GBS remain the most common causes of bacterial meningitis in the first 90 days of life. For empirical therapy of suspected bacterial meningitis, one should consider a third-generation cephalosporin (plus ampicillin for at least the first month), potentially substituting a carbapenem for the cephalosporin if there is evidence for Gram-negative meningitis.
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