Etiology and Clinical Features of Full-Term Neonatal Bacterial Meningitis: A Multicenter Retrospective Cohort Study

Abstract

Objective: Neonatal bacterial meningitis is a severe infectious disease with a high risk of neurodevelopmental sequelae. The causative pathogens may be related to specific clinical features of the disease. Therefore, this study aimed at determining the pathogen-specific and clinical features of bacterial meningitis in full-term neonates. Methods: We enrolled neonates from the Shanghai Neonate Meningitis Cohort (2005–2017), which is a multicenter retrospective cohort that recruits almost all full-term neonates in Shanghai who underwent lumbar puncture. Patient history and clinical examination results were extracted from the computer-documented information systems of four hospitals. The trends of pathogen distribution were analyzed and differences in the clinical manifestations, treatment, and clinical outcomes at discharge were compared according to the causative pathogen. Logistic regression was used to evaluate the pathogen-specific risk of neurological complications. Results: In total, 518 cases of neonatal meningitis, including 189 proven cases, were included. Group B Streptococcus (GBS) and Escherichia coli ( E. coli ) were the leading pathogens in proven cases of early-onset and late-onset neonatal meningitis, respectively. The proportion of early-onset and late-onset GBS and late-onset E. coli meningitis cases increased gradually. GBS meningitis had the highest risk of neurological complications, whereas the overall incidence of hydrocephalus and brain abscess in E. coli was higher than that in GBS. Conclusions: Rates of neonatal GBS and E. coli meningitis were high in 2005–2017 in Shanghai, and the risk of neurological complications was also high. Therefore, active prevention, rational use of antibiotics, and continuous monitoring of GBS and E. coli in neonates should be initiated in Shanghai.

Histopathological changes to the peripheral vestibular system following meningitic labyrinthitis

“…Most studies focus on cochlear changes, since the prevalence of SNHL is close to 54% after meningitis. As described previously, infection reaches the perilymphatic spaces causing a reactive immune response and damage to the inner ear structures, such as the organ of Corti or the SGN, resulting in SNHL . Meningitis caused by S. pneumoniae is the most common form of bacterial meningitis, and it is of particular interest to otologists due to its association with purulent otitis media in 20% to 30% of cases, which may result in hearing loss in up to 30% of survivors .…”

“…Meningitis is a major cause of mortality and morbidity worldwide . It is estimated that the incidence of bacterial meningitis is about 0.8‐2.6 per 100 000 adults in developed countries . The most common causative microorganisms are the Haemophilus influenzae type B (Hib), Streptococcus pneumoniae , and Neisseria meningitidis .…”

“…The most common causative microorganisms are the Haemophilus influenzae type B (Hib), Streptococcus pneumoniae , and Neisseria meningitidis . The overall incidence of bacterial meningitis as well as its morbidity has decreased due to the introduction of vaccines, implementation of effective antibiotic and steroid therapy, and modern intensive care facilities . Despite improved outcomes, meningitis remains an important public health issue, especially in developing nations .…”

“…The overall incidence of bacterial meningitis as well as its morbidity has decreased due to the introduction of vaccines, implementation of effective antibiotic and steroid therapy, and modern intensive care facilities . Despite improved outcomes, meningitis remains an important public health issue, especially in developing nations . Worse, it can increase its incidence and transmissibility again when families decide not to vaccinate their children …”

“…Sensorineural hearing loss (SNHL) may affect up to 54% of survivors following meningitis . Likewise, vestibular dysfunction also occurs frequently and is nearly universal in those with SNHL .…”