Incidence, Etiology, and Outcome of Bacterial Meningitis in Infants Aged &lt;90 Days in the United Kingdom and Republic of Ireland: Prospective, Enhanced, National Population-Based Surveillance

Okike, Ifeanyichukwu; Johnson, Alan P.; Henderson, Katherine L.; Blackburn, Ruth; Müller‐Pebody, Berit; Ladhani, Shamez; Anthony, Mark; Ninis, Nelly; Heath, Paul T

doi:10.1093/cid/ciu514

Cited by 168 publications

(155 citation statements)

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“…In the first 30 days of life, L. monocytogenes was the third most common bacteria, responsible for 6% of cases (compared with 7% and 5% (for the first 28 days) in the previous national studies). The median age of meningitis due to L. monocytogenes was 13 days (IQR 3–18 days) with the oldest infant being 29 days; Listeria meningitis was therefore not seen beyond the 1st month of life 5. Of the 11 cases of Listeria meningitis, 7 (64%) were female, 2/9 (22%) were born preterm (<37 weeks gestation) and 6/9 (67%) first became unwell when at home.…”

Section: Current Epidemiologymentioning

confidence: 99%

Empirical antibiotic cover for Listeria monocytogenes infection beyond the neonatal period: a time for change?

et al. 2015

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Listeria monocytogenes is a Gram-positive bacterium which can cause invasive infection in the immunocompromised, pregnant women and young infants. Listeria are not susceptible to the third generation cephalosporins (such as cefotaxime or ceftriaxone) usually given as empirical antibiotic treatment to unwell children. Amoxicillin or ampicillin is thus added for infants less than 3 months of age with suspected serious bacterial infection. However empirical antibiotic cover for L. monocytogenes infection beyond the neonatal period may not be needed. CURRENT RECOMMENDATIONThe National Institute of Health and Care Excellence (NICE) clinical guidelines on 'Feverish illness in children' (2007) 1 and 'Bacterial meningitis and meningococcal septicaemia' (2010) 2 recommend that the empirical antibiotic cover for infants 0-3 months of age admitted from home with suspected serious bacterial infection should be amoxicillin and cefotaxime. 1 2 This recommendation reflects the range of bacterial pathogens that cause these serious infections in the first 3 months of life. The inclusion of amoxicillin specifically acknowledges the importance of L. monocytogenes and highlights its non-susceptibility to thirdgeneration cephalosporins. CURRENT EPIDEMIOLOGYPopulation-based surveillance undertaken in England and Wales in the 1980s and 1990s showed that the aetiology and incidence of neonatal bacterial meningitis changed very little over this period with Group B streptococci and Escherichia coli being the leading causative organisms, followed by L. monocytogenes. 3 4 A more recent population-based surveillance study of bacterial meningitis in infants aged <90 days in the UK and Ireland undertaken between July 2010 and July 2011 showed that these three causative bacteria remained dominant, and that their frequency varied significantly by month of life. In the first 30 days of life, L. monocytogenes was the third most common bacteria, responsible for 6% of cases (compared with 7% and 5% (for the first 28 days) in the previous national studies). The median age of meningitis due to L. monocytogenes was 13 days (IQR 3-18 days) with the oldest infant being 29 days; Listeria meningitis was therefore not seen beyond the 1st month of life. 5 Of the 11 cases of Listeria meningitis, 7 (64%) were female, 2/9 (22%) were born preterm (<37 weeks gestation) and 6/9 (67%) first became unwell when at home. Outcome was known in nine cases and all survived although two cases (22%) had a serious complication at discharge (one baby had hydrocephalus while the second baby had focal neurological signs).A summary of all cases of L. monocytogenes infection (sepsis and meningitis inclusive) in infants <1 year of age reported to Public Health England over the 24 years period between 1990 and 2013 is shown in tables 1 and 2. This data expands on previously published surveillance. 6 Ninety-seven per cent of all cases (351/362), and 99% of all cases occurring in the first 90 days of life (351/356), presented in the first 30 days of life. Clinical presentation was kn...

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Section: Current Epidemiologymentioning

confidence: 99%

Empirical antibiotic cover for Listeria monocytogenes infection beyond the neonatal period: a time for change?

et al. 2015

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“…In the UK, it is the third most common cause of early-onset neonatal infection [3] and the fourth most common cause of early-onset neonatal meningitis [7]. It manifests commonly in the first 24 to 72 hours of life (62% of cases) [3].…”

Section: Introductionmentioning

confidence: 99%

Neonatal listeriosis in the UK 2004–2014

Sapuan

Kortsalioudaki

Anthony

et al. 2017

Journal of Infection

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ObjectiveTo define the clinical features and outcomes of neonatal listeriosis, and identify the maternal risk factors to seek scope for improvement. MethodsNeonatal listeriosis was identified prospectively from a United Kingdom neonatal infection surveillance network (neonIN) between 2004 and 2014. The participating neonatal units completed a study-specific proforma. ResultsThe incidence of neonatal listeriosis was 3.4 per 100,000 live births. Of the 21 cases identified, 19 were confirmed with a median gestational age of 33 weeks and a median birth weight of 1960g. The majority had clinical features (95%, 18/19), presented within the first 24 hours (95%, 18/19), and received penicillin empirically (94%, 18/19). The neonatal casefatality rate was 21% (24% if probable cases were included). A proportion of mothers were investigated (60%, 12/18) and diagnosed with listeriosis (58%, 7/12); 32% (6/19) were treated with antibiotics but only 33% (6/12) included penicillin. DiscussionDespite its rarity and the prompt and appropriate use of antibiotics neonatal listeriosis has a high case-fatality rate. There is room for improvement in the adherence to the national guidance in the choice of empiric antibiotics for puerperal sepsis, which would target listeriosis. Strategies should be in place to prevent pregnancy-associated listeriosis in higher risk population.

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“…Although intrapartum antibiotic prophylaxis (IAP) to at-risk or GBS-colonized pregnant women has successfully reduced the burden of early-onset disease (<7 days age; EOD) [3], GBS remains the commonest cause of sepsis and meningitis in young infants in high-income countries [4–6]. In many low and middle income countries (LMIC), laboratory resource constrains, difficulty with accessing health care facilities, empiric antibiotic treatment prior to hospital referral and differing thresholds for investigating bacterial disease might hamper identification of pathogens associated with severe bacterial infections, including GBS [7–9].…”

Section: Introductionmentioning

confidence: 99%

Temporal Changes in Invasive Group B Streptococcus Serotypes: Implications for Vaccine Development

et al. 2016

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IntroductionThere is a paucity of longitudinal data on the serotype-specific burden of invasive group B Streptococcus (GBS) disease from low-middle income countries, which could inform selection of vaccine epitopes.MethodsFrom 2005 to 2014, infants less than 90 days of age with invasive GBS disease were identified through sentinel laboratory and hospital admission surveillance at Chris Hani Baragwanath Academic Hospital in Soweto, South Africa.ResultsWe identified 820 cases of invasive GBS disease, including 55% among newborns <7 days age (i.e. early-onset disease; EOD). The overall incidence (per 1,000 live births) of invasive GBS disease was 2.59 (95% CI: 2.42–2.77), including 1.41 (95% CI: 1.28–1.55) for EOD and 1.18 (95% CI: 1.06–1.30) in infants 7–89 days age (late-onset disease). Year-on-year, from 2005 to 2014, we observed a 9.4% increase in incidence of serotype Ia invasive disease (RR: 1.09; 95% CI: 1.04–1.15; p<0.001), and a 7.4% decline in serotype III invasive disease (RR: 0.93; 95% CI: 0.90–0.96; p<0.001). Overall, serotypes Ia (28.2%), III (55.4%) and V (7.9%) were the commonest disease causing serotypes.ConclusionsThe incidence of invasive GBS disease has remained persistently high in our setting, with some changes in serotype distribution, albeit mainly involving the same group of dominant serotypes.

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Incidence, Etiology, and Outcome of Bacterial Meningitis in Infants Aged <90 Days in the United Kingdom and Republic of Ireland: Prospective, Enhanced, National Population-Based Surveillance

Abstract: The incidence of bacterial meningitis in young infants remains unchanged since the 1980s and is associated with significant case fatality. Prevention strategies and guidelines to improve the early management of cases should be prioritized.

Cited by 168 publications

References 20 publications

Empirical antibiotic cover for Listeria monocytogenes infection beyond the neonatal period: a time for change?

Empirical antibiotic cover for Listeria monocytogenes infection beyond the neonatal period: a time for change?

Neonatal listeriosis in the UK 2004–2014

Temporal Changes in Invasive Group B Streptococcus Serotypes: Implications for Vaccine Development

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