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Bacterial meningitis in infants two to six weeks old
Abstract:
We reviewed our experience with bacterial meningitis in older neonates (2 to 6 weeks of age) during a five-year period. Seventeen patients with bacterial meningitis were diagnosed and treated. Bacteria recovered from the cerebral spinal fluid (CSF) included pneumococci (29%), E. coli and meningococci (23% each), group B streptococci (12%), Enterobacter and H. influenzae (6% each). There were no cases of Listeria monocytogenes. The mean duration of symptoms before admission was 3.1 days. The mortality rate was high (30%), and 36% of the patients had significant neurologic residua. Our study shows that this specific age group is different from newborns or older infants. Therefore, the initial selection of antibiotics for the treatment of meningitis in this age group should include antibiotics that are effective across this spectrum of potential pathogens.
Insights
Bacterial meningitis in older neonates (2-6 weeks) presents unique challenges. Early antibiotic selection must cover a broad spectrum of pathogens due to high mortality and neurologic sequelae in this distinct age group.
Area of Science:
- Pediatrics
- Infectious Diseases
- Neonatology
Background:
- Bacterial meningitis is a serious infection in neonates.
- Older neonates (2-6 weeks) represent a distinct demographic with potentially different causative agents and outcomes compared to younger infants.
Purpose of the Study:
- To review the experience with bacterial meningitis in older neonates.
- To identify common pathogens, treatment outcomes, and associated neurologic sequelae.
- To inform optimal antibiotic selection for this specific age group.
Main Methods:
- Retrospective review of 17 patients diagnosed with bacterial meningitis.
- Analysis of causative bacteria isolated from cerebrospinal fluid (CSF).
- Evaluation of clinical presentation, treatment, mortality, and neurologic outcomes.
Main Results:
- Common pathogens included pneumococci (29%), E. coli (23%), meningococci (23%), group B streptococci (12%), Enterobacter (6%), and H. influenzae (6%).
- No Listeria monocytogenes infections were observed.
- High mortality rate (30%) and significant neurologic residua (36%) were noted.
- Mean duration of symptoms before admission was 3.1 days.
Conclusions:
- Older neonates with bacterial meningitis exhibit a different spectrum of pathogens than younger infants.
- The high mortality and morbidity underscore the need for prompt and appropriate treatment.
- Empiric antibiotic therapy should encompass the identified spectrum of potential pathogens in this age group.