Survey of neonatal meningitis in Australia: 1987–1989

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Abstract
To identify incidence, bacterial aetiology, outcome after treatment and risk factors for poor outcome of neonatal meningitis. Retrospective survey of neonatal meningitis occurring in Australia between January 1987 and December 1989. Data were obtained from Medical Records and Microbiology Departments of hospitals with neonatal nurseries. Neonatal nurseries throughout Australia. 116 infants under 6 weeks of age with bacterial or fungal meningitis. The minimum incidence was 0.17 per 1000 live births. Traditional neonatal pathogens were responsible for 60% of cases (group B streptococci, 35%; Escherichia coli, 22%), childhood meningeal pathogens for 10% and opportunistic pathogens for 30%. Risk factors for meningitis, including prematurity, were more common among those with meningitis due to E. coli or opportunistic pathogens than among those with infections due to group B streptococci, Listeria monocytogenes or the childhood pathogens (46/60 v. 11/55; P less than 0.0001). Meningitis was more likely to be due to Gram-negative bacteria in premature infants (less than 36 weeks gestation) than in full-term infants (19/30 v. 20/86; P = 0.0002). The mortality overall was 26% but was higher in extremely premature infants (less than 29 weeks) (6/9 v. 24/107; P = 0.009) and among 13 patients who were judged to have had inappropriate initial therapy (7/13 v. 21/97; P = 0.04). Long-term sequelae occurred in at least 23% of survivors, but were more common in those with Gram-negative meningitis (6/10 v. 13/76; P = 0.012). Initial therapy with penicillin or amoxycillin plus cefotaxime is appropriate for most infants with bacterial meningitis. Since some less common Gram-negative bacteria isolated in this survey were resistant to cefotaxime, an aminoglycoside should be added, initially, in Gram-negative meningitis.