416 - Bacterial Meningitis in a Quaternary NICU: A Multiyear Retrospective Study

Sunday, April 30, 2023

3:30 PM – 6:00 PM ET

Poster Number: 416
Publication Number: 416.335

Olivia O'Hearn, Childrens Hospital of Philadelphia, Sparta, NJ, United States; Lakshmi Srinivasan, CHOP - 3401 Civic Center BlvdPhiladelphia, PA 19104-4319UNI, Philadelphia, PA, United States; Matt Devine, Childrens Hospital of Philadelphia, Collingswood, NJ, United States; Mary C. Harris, Childrens Hospital of Philadelphia, Gladwyne, PA, United States

Presenting Author(s)

LS

Lakshmi Srinivasan, MBBS MTR (she/her/hers)

Assistant Professor
CHOP - 3401 Civic Center BlvdPhiladelphia, PA 19104-4319UNI
Philadelphia, Pennsylvania, United States

Background: Bacterial meningitis is a significant cause of morbidity and mortality in infants. Confirming a meningitis diagnosis may be difficult because a lumbar puncture (LP) is often deferred until results of blood cultures (BCs) are known and sometimes not considered, making this population susceptible to a missed diagnosis.

Objective: To identify risk factors and causative organisms of meningitis in a level IV NICU and to compare pathogen specificity and rates of concordant bacteremia between infants with and without neurosurgical devices.

Design/Methods: We reviewed medical records of infants < 1 year of age in the Level 4 NICU at the Children’s Hospital of Philadelphia from June 2007– October 2021 who were diagnosed with bacterial meningitis. Analysis included summary descriptive statistics and Fisher’s exact test.

Results: Among 95 infants (101 episodes), 61% were preterm with a median GA of 35 weeks and median postnatal age of 30 days (Table 1). Six infants had recurrent meningitis; 2 had polymicrobial meningitis and 6 died. Twenty-seven infants (28%) had a neurosurgical (NS) device (ventriculoperitoneal shunt, Ommaya reservoir, external ventricular drain) at the time of meningitis diagnosis. Overall, 63/98 episodes (62%) had positive BCs; among them, 59/72 episodes (82 %) had positive BCs in the absence of a NS device while 15% of episodes in infants with NS devices had concomitant bacteremia (4/27) (p< 0.0001) (3 infants had unknown BC results). Group B streptococcus (GBS) accounted for 28% (n=29), and Escherichia coli (E. coli) for 19% (n=20) episodes. Among 29 microorganisms identified in cerebrospinal fluid (CSF) from 27 infants with NS devices, 34% (n=10) were Coagulase-negative staphylococcus (CONS) and 31% (n=9) were Staphylococcus aureus (S.aureus).

Conclusion(s):

Meningitis was diagnosed in the absence of a positive BC in 38% of infants, underscoring the importance of an LP in infants evaluated for sepsis. Further, infants with NS devices rarely had concomitant positive BCs. Although GBS and E. coli remain most prevalent overall, CONS and S.aureus are common pathogens in patients with neurosurgical devices. Our data support selection of empiric antimicrobial regimens based on presumed pathogenesis of infection (bacteremic spread to meninges versus shunt infection) in this vulnerable patient population.