The Epidemiology of Meningitis in Infants under 90 Days of Age in a Large Pediatric Hospital.

BACKGROUND

Meningitis is associated with substantial morbidity and mortality, particularly in the first three months of life.

METHODS

We conducted a retrospective review of patients <90 days of age with meningitis at Texas Children's Hospital from 2010-2017. Cases were confirmed using the National Healthcare Safety Network (NHSN) definition of meningitis.

RESULTS

Among 694 infants with meningitis, the most common etiology was viral ( = 351; 51%), primarily caused by enterovirus ( = 332; 95%). A quarter of cases were caused by bacterial infections ( = 190; 27%). The most common cause of bacterial meningitis was group B (GBS, = 60; 32%), followed by Gram-negative rods other than ( = 40; 21%), and ( = 37; 19%). The majority of Gram-negative organisms (63%) were resistant to ampicillin, and nearly one-fourth of Gram-negative rods (23%) other than and 2 (6%) isolates were resistant to third-generation cephalosporins. Significant risk factors for bacterial meningitis were early preterm birth and the Black race.

CONCLUSIONS

Enteroviruses most commonly caused viral meningitis in infants; GBS was the most common bacterial cause despite universal screening and intrapartum prophylaxis. The emergence of MRSA and resistance to third-generation cephalosporins in Gram-negative bacterial meningitis challenges the options for empirical antimicrobial therapy.