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Updated: Jun 4, 2025
A Neonatal Imaging Model of Gram-Negative Bacterial Sepsis
Published on: August 12, 2020
Bacterial meningitis in a quaternary NICU: A multiyear retrospective study
Olivia O'Hearn1, Lakshmi Srinivasan1,2, Matthew Devine1
1University of Pennsylvania, Philadelphia, PA.
Abstract:
Bacterial meningitis causes significant morbidity and mortality in infants. Lumbar punctures are often deferred until the results of blood cultures are known and sometimes not considered, making this population susceptible to a missed diagnosis. There are few studies describing the epidemiology of neonatal meningitis in quaternary neonatal intensive care unit settings. We describe the epidemiology of meningitis in a level IV neonatal intensive care unit; compare pathogens and rates of concordant bacteremia between infants with and without neurosurgical (NS) devices. Retrospective review of infants < 1 year of age in the Children's Hospital of Philadelphia neonatal intensive care unit with bacterial meningitis (June 2007-October 2021). Analysis included summary statistics, Wilcoxon rank sum, Chi square, and Fisher exact tests. We identified 101 episodes of bacterial meningitis (95 infants). 9 infants died. At diagnosis, 26 infants (27%) had NS devices. Group B streptococcus (GBS) and Escherichia coli (E coli) were most common pathogens, however, coagulase-negative staphylococci and Staphylococcus aureus (S aureus) predominated among infants with NS devices. While 86% had positive blood cultures in the absence of a NS device, only 14% of episodes with NS devices had concomitant bacteremia (P < .0001). Although Group B streptococcus and E coli remain most prevalent overall, coagulase-negative staphylococci and S aureus were common pathogens in NS patients. Infants with NS devices rarely had concomitant bacteremia. Meningitis was diagnosed in the absence of a positive blood culture in 36% of episodes, underscoring the importance of developing guidance for lumbar punctures in infants evaluated for sepsis.
Insights
Neonatal bacterial meningitis is serious, especially in infants with neurosurgical devices. These infants rarely have bloodstream infections, increasing the risk of missed diagnoses and highlighting the need for better lumbar puncture guidelines.
Area of Science:
- Neonatal Medicine
- Infectious Diseases
- Pediatric Neurology
Background:
- Bacterial meningitis poses significant risks in infants, with delayed diagnosis contributing to morbidity and mortality.
- Neonatal meningitis epidemiology, particularly in quaternary neonatal intensive care units (NICUs), is not well-described.
- Infants with neurosurgical (NS) devices may have unique meningitis pathogen profiles and diagnostic challenges.
Purpose of the Study:
- To describe the epidemiology of bacterial meningitis in a level IV NICU.
- To compare pathogens and rates of bacteremia between infants with and without NS devices.
- To identify diagnostic challenges in neonatal meningitis, especially in the context of NS devices.
Main Methods:
- Retrospective review of infants under 1 year with bacterial meningitis at a children's hospital NICU (June 2007-October 2021).
- Analysis included statistical comparisons of infants with and without NS devices, focusing on pathogens and blood culture concordance.
- Data collected on patient demographics, pathogens, NS device presence, and blood culture results.
Main Results:
- 101 episodes of bacterial meningitis in 95 infants were identified; 9 infants died.
- Group B Streptococcus (GBS) and Escherichia coli (E. coli) were common overall, but coagulase-negative staphylococci and Staphylococcus aureus predominated in infants with NS devices.
- Concordant bacteremia was significantly lower in infants with NS devices (14%) compared to those without (86%) (P < .0001).
- Meningitis was diagnosed without a positive blood culture in 36% of cases.
Conclusions:
- While GBS and E. coli are prevalent, S. aureus and coagulase-negative staphylococci are key pathogens in infants with NS devices.
- The low rate of bacteremia in infants with NS devices complicates diagnosis and underscores the need for careful consideration of lumbar punctures.
- Current diagnostic approaches may miss meningitis in infants, particularly those with NS devices, necessitating revised clinical guidelines for sepsis evaluation.
