084 - Epidemiology, neurologic complications, and outcomes in young infants with bacterial meningitis: a single-institution, retrospective cohort study

Publication Number: 84.5030

Nehali Mehta, Children's Hospital of Philadelphia, Philadelphia, PA, United States; Mary Catherine C. Harris, Children's Hospital of Philadelphia, Gladwyne, PA, United States; Leah Loerinc, Childrens Hospital of Philadelphia, Philadelphia, PA, United States; Olivia O'Hearn, Childrens Hospital of Philadelphia, Philadelphia, PA, United States; Matt Devine, Childrens Hospital of Philadelphia, Collingswood, NJ, United States; Sanjeev Swami, Childrens Hospital of Philadelphia, Philadelphia, PA, United States; Jennifer McGuire, Childrens Hospital of Philadelphia, Philadelphia, PA, United States

Background: Bacterial meningitis remains an important cause of morbidity and mortality in infants.

Objective: 1) Describe the epidemiology of culture-positive bacterial meningitis in young infants 2) define risk factors for the development of neurologic complications by causative organism and 3) describe clinical outcomes.

Design/Methods: This is a single-center retrospective cohort study of infants ≤6 months corrected gestational age admitted to a tertiary care children’s hospital for culture-positive bacterial meningitis between 01/01/2011-7/31/2023. Infants were included if they had 1) a positive cerebrospinal fluid (CSF) culture or positive blood culture with CSF pleocytosis; and 2) received treatment for bacterial meningitis. Infants with history of prior neurosurgery, existing intracranial devices, or known immunodeficiency at the time of positive culture were excluded. Pathogen groups were defined as: 1) Group B streptococcus (GBS) 2) Enteric gram-negative pathogens (E coli, Klebsiella species, Enterobacter species, Citrobacter species, Serratia species) and 3)Respiratory pathogens (H influenzae, S pneumoniae, N meningitidis). Multivariate models were built to examine risk factors for specific neurologic complications.

Results: Demographics and clinical features of the cohort (n=80) are described in Table 1. The median age at first positive culture was 26 days, and 46% were premature (range 23-42 weeks). The most common causative organisms were GBS (43%), E coli (25%), and S pneumoniae (9%). There was no significant difference in pathogen distribution by year (p=0.15), but the absolute number of cases was higher between 2020-2022 (Figure 1). A higher proportion of infants with respiratory pathogens and GBS had an abnormal neurologic exam at the time of positive culture compared to infants with enteric gram-negative pathogens (p=0.02, Table 2). Among 62 infants who had neuroimaging, enteric gram-negative pathogens were associated with hydrocephalus (aOR= 5.4, p=0.010), white matter injury (aOR=6.5, p=0.014), and cerebral venous thrombosis (aOR = 5.6, p=0.05) when adjusted for prematurity. A higher proportion of infants with enteric gram-negative pathogens required neurosurgical intervention (p=0.019), including permanent CSF diversion (p=0.032), compared to infants with GBS or respiratory pathogens.

Conclusion(s): GBS and E coli remain the most common causative organisms of bacterial meningitis in infants. Consider neuroimaging and close follow-up in infants with gram-negative enteric meningitis to evaluate for neurologic complications such as hydrocephalus, cerebral venous thrombosis, and white matter injury.

Table 1: Demographics, laboratory results, and neurological studies in young infants with culture-positive bacterial meningitis
CHOP_Neonatal Meningitis_PAS Table1.pdf

Table 2: Neurologic complications and outcomes in infants with culture-positive bacterial meningitis
CHOP_Neonatal Meningitis_PAS Abstract_Table2.pdf

Figure 1: Number of young infants with bacterial meningitis over time, organized by pathogen group.
*p-value represents difference in pathogen proportions by time period. **2023 data is limited to 7 months (January through July 2023).