Paediatric Investigators Collaborative Network on Infections in Canada (PICNIC) Study of the Epidemiology of Bacterial and Fungal Meningitis in Infants Aged <90 Days

Abstract

Background. Bacterial and fungal meningitis remain a cause of mortality and morbidity in young infants. There is a paucity of information on bacterial meningitis in North America in the era of infant pneumococcal vaccine and intra-partum group B streptococcus (GBS) prophylaxis. Methods. A retrospective chart review for all newborns from 0 to 90 days of age was performed in 8 centers across Canada for the years 2013 and 2014 to describe the etiology and outcome of bacterial and fungal meningitis. Cases were identified through search of ICD-10 codes. Results. A total of 113 cases of bacterial meningitis and one case of Candidal meningitis were identified. Sixty-four were proven cases with bacteria or fungi identified in CSF and 50 were suspected cases, with CSF pleocytosis and bacteria identified at another sterile site. Pathogens were Escherichia coli (E. coli) (37/114 [32.5%]) GBS (35/ 114 [30.7%]) and other Gram negative and positive bacteria (29/114 [25.4%]). The remaining cases were divided between N. meningitidis (N = 4), Hemophilus influenzae type B (Hib) (N = 3), Listeria (N = 3) and Streptococcus pneumoniae (N = 1). Seventeen cases (14.9%) of early-onset (day 0-6) meningitis, 63 (55.2%) of late-onset (day 7-29) and 34 (29.8%) of very late-onset (day 30-89) were identified. Amongst the early-onset cases GBS was the leading cause (8/17 [47.4%]) cases and E. coli represented 4 cases (23.5%). The candidal meningitis and one case of Hib were amongst the early-onset. In the late onset cases, the leading cause was E. coli (24/63 [38.1%]) followed by other bacteria (19/63[30.2%]) and GBS (16/63 [25.4%]). The remaining late-onset were Listeria (N = 3) and Neisseria meningitidis (N = 1). GBS predominated in the very lateonset category (11/34 [32.4%]) followed by E. coli (9/34 [25.7%]) and other bacteria (8/34 [23.5%]). In the remaining very late-onset cases were N. meningitis (N = 3), Hib (N = 2) and Streptococcus pneumoniae (N = 1). The case fatality rate was 6% (7/114) cases. Thirty-nine patients (34.2%) had seizures after onset of CNS symptoms, 22 (19.3%) patients developed hydrocephalus of which 14 (12.3%) required CSF shunts. Conclusion. GBS and E. coli remain the two leading causes of bacterial meningitis amongst neonates in Canada. The case fatality rate and morbidity remain significant and warrant the need for development of new strategies to prevent both early and late onset GBS meningitis.