What Lurks in Infant CSF These Days?

Spoon Feed
E. coli and GBS were the most common pathogens causing meningitis in infants under 90 days in this cohort. Add ampicillin for the first month to cover Listeria.  If gram-negative meningitis is present (or gram stain is negative), consider changing to a carbapenem (like meropenem).

Why does this matter?
Appropriate antibiotic selection in infants with meningitis may mean the difference in life and death or disability vs a functional outcome.  This is a core area of knowledge every emergency physician must have.

What's growing in CSF these days?
In the era of antibiotic resistance, modern vaccines, and GBS prophylaxis, what are the current causes of meningitis in infants < 90 days?  This study of 7 Canadian tertiary care hospitals found 113 cases of meningitis - 63 proven; 50 suspected.  The most common pathogen was E. coli followed by group B strep.  There were some Listeria and resistant gram-negatives, so the authors conclude with the recommendation to be sure and add ampicillin during the first month and to consider changing to a carbapenem (as opposed to cefotaxime or ceftriaxone) if gram-negative meningitis was present or the gram stain was negative.  Clinically significant complications occurred in 74% and death in 7%.

Source
The Epidemiology, Management, and Outcomes of Bacterial Meningitis in Infants.  Pediatrics. 2017 Jun 9. pii: e20170476. doi: 10.1542/peds.2017-0476. [Epub ahead of print]

Peer reviewed by Thomas Davis.