Early Effective Antibiotic Therapy and Meningitis Following a Bloodstream Infection in Hospitalized Infants: A Cohort Study.

Abstract

Objective: To evaluate the role of early effective antibiotic therapy in preventing secondary meningitis as a sequelae of bacterial bloodstream infections (BSI).

Study design: In this multicenter cohort study, we identified blood cultures that were positive for Group B Streptococcus (GBS), Staphylococcus aureus, Escherichia coli, and other non-E. coli gram-negative bacteria that had a corresponding cerebrospinal fluid sample collected ≤7 days after the positive blood culture among infants discharged from a neonatal intensive care unit managed by the Pediatrix Medical Group 2002 - 2020. The odds of secondary meningitis for early effective antibiotic therapy vs delayed antibiotic therapy were compared using an adjusted logistic regression model. The odds of secondary meningitis following GBS BSI were compared for infections treated with empirical vancomycin vs beta-lactam antibiotic.

Results: Secondary meningitis was identified in 11% of 5967 BSI. Early effective antibiotic therapy was not associated with a reduced odds of secondary meningitis for GBS (aOR 1.17; 95% CI, 0.82-1.66) or E. coli (aOR 1.06; 95% CI, 0.82-1.38); however, was associated with decreased odds for non-E. coli gram-negative bacteria (aOR 0.69; 95% CI, 0.49-0.98) and S. aureus (aOR 0.51; 95% CI, 0.34-0.74). GBS BSI were more often complicated by meningitis when vancomycin was used empirically compared to beta-lactam antibiotic (aOR 2.01; 95% CI, 1.28- 3.14).

Conclusion: Early effective antibiotic therapy for BSI in infants did not reduce the odds of secondary meningitis caused by GBS or E. coli; however, early effective antibiotic therapy did reduce episodes due to non-E. coli gram-negative bacteria and S. aureus.