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A Neonatal Imaging Model of Gram-Negative Bacterial Sepsis
Published on: August 12, 2020
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Bacterial meningitis in a quaternary NICU: A multiyear retrospective study
Olivia O'Hearn1, Lakshmi Srinivasan1,2, Matthew Devine1
1University of Pennsylvania, Philadelphia, PA.
Medicine
|December 20, 2024
Summary
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.
