Bacterial meningitis contracted within the first 90 days of life was most commonly attributed to infection from Escherichia coli and group B Streptococcus, each accounting approximately one-third of cases, according to research published in Pediatrics.
The researchers also suggest using a third-generation cephalosporin for empirical therapy for bacterial meningitis, with ampicillin used additionally for at least first month; this would replace the use of a carbapenem in cases of gram-negative meningitis.
“There is a paucity of information on the characteristics of neonatal meningitis in the era of infant Haemophilus influenzae type B and pneumococcal immunization, maternal group B Streptococcus prophylaxis, and emerging antimicrobial resistance,” Lynda Ouchenir, MD, from the CHU Sainte-Justine Mother and Child University Hospital, Quebec, and colleagues wrote.
To examine which antibiotics would most effectively treat bacterial meningitis in early infancy, the researchers assessed infants younger than 90 days of age who contracted bacterial meningitis at seven pediatric tertiary care hospitals between 2013 and 2014.
The researchers identified 113 patients diagnosed with either proven meningitis (n = 63) or suspected meningitis (n = 50), with a median age of 19 days, with 56% of these patients presenting a diagnosis from home.
According to study results, the most commonly observed pathogens among neonatal patients included E coli (n = 37, 33%) and GBS (n = 35, 31%).
The researchers noted that two of 15 patients presenting with meningitis within the first 6 days of life exhibited isolates resistant to both ampicillin and gentamicin (E. coli and Haemophilus influenzae type B).
Among the 60 patients presenting from home between 7 and 90 days of life, six had isolates that made cefotaxime an ill-suited choice, including Listeria monocytogenes (n = 3), Enterobacter cloacae (n = 1), Cronobacter sakazakii (n = 1), and Pseudomonas stutzeri (n = 1). Additionally, eight deaths occurred, and 74% of infants had documented sequelae.
“The burden of GBS meningitis remains significant with a mortality rate of 14%, with the five deaths occurring in term and preterm infants with a wide range of age onset — 1 to 59 days of life,” Ouchenir and colleagues wrote. “There is a need for additional strategies for prevention of early- and late-onset disease.” –Katherine Bortz
Disclosure: The researchers provide no relevant financial disclosures.