559 - Epidemiology of bacterial and fungal meningitis among very preterm infants in China

Poster Number: 559
Publication Number: 559.1186

Background: Neonatal meningitis is a serious central nervous system infection associated with high morbidity and mortality. Ongoing surveillance of epidemiology is essential.

Objective: To describe the incidence, pathogen distribution, the usage of antimicrobial agents, and short-term outcomes of bacterial and fungal meningitis among very preterm infants (VPIs) in China.

Design/Methods: This study included all infants with gestational age < 32 weeks or birth weight < 1500 g, who were admitted to tertiary-level NICUs of the Chinese Neonatal Network (CHNN) from January 2019 to December 2021. Culture-positive neonatal meningitis was defined by positive cerebral spinal fluid culture of bacteria or fungi. Early-onset meningitis was defined as diagnosis at ≤6 days of age; late-onset meningitis was defined as diagnosis at >6 days of age. Meningitis-related death was defined as death occurred within 7 days of the positive cerebral spinal fluid culture.

Results: A total of 31915 very preterm infants were admitted to CHNN NICUs in three years. Overall, 122 (0.38%) infants were diagnosed with culture-positive meningitis, including 14 (11.5%) infants with early-onset meningitis and 108 (88.5%) infants with late-onset meningitis. The median gestational age of infants with meningitis was 29.6 (28.0, 31.0) weeks, and the median birth weight was 1240 (1040, 1445) g. The overall in-hospital mortality of infants with meningitis was 18.0% (22/122), and meningitis-related mortality was 9.8% (12/122). A total of 127 pathogens were identified. Of the 15 pathogens causing early-onset meningitis, the most common pathogen was Escherichia coli in 33.3% (5/15). Among the 112 pathogens causing late-onset meningitis, the most common pathogens were Klebsiella pneumoniae (16.3%, 16/112), coagulase-negative staphylococci (13.4%, 15/112), Escherichia coli (9.8%, 11/112), and Candida albicans (8.0%, 9/112). In terms of empirical therapy on the day of meningitis onset, the commonly used antibiotics were meropenem (54.9%, 67/122). In terms of definitive therapy, among 58 infants with Gram-negative bacterial meningitis, the most common antibiotic used was meropenem (60.3%, 35/58). Among 28 infants with Gram-positive bacterial meningitis, the most common antibiotic was vancomycin (57.1%,16/28).

Conclusion(s): Around 0.38% of VPIs admitted to Chinese NICUs were diagnosed culture-proven meningitis with significant case fatality. Gram-negative bacteria caused over 60% of all meningitis, and fungi were important pathogens for late-onset infections. Standardized guidelines are needed to optimize the antibiotic treatment for meningitis among VPIs.