Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • Original Article
  • Published:

A comparison of neonatal Gram-negative rod and Gram-positive cocci meningitis

Journal of Perinatology volume 26, pages 111–114 (2006)Cite this article

Abstract

Objective:

Neonatal meningitis is an illness with potentially devastating consequences. Early identification of potential risk factors for Gram-negative rod (GNR) infections versus Gram-positive cocci (GPC) infection prior to obtaining final culture results is of value in order to appropriately guide expirical therapy. We sought to compare laboratory and clinical parameters of GNR and GPC meningitis in a cohort of term and premature infants.

Study Design:

We evaluated lumbar punctures from neonates cared for at 150 neonatal intensive care units managed by the Pediatrix Medical Group Inc. We compared cerebrospinal fluid (CSF) parameters (white blood cell count, red blood cell count, glucose, and protein), demographics, and outcomes between infants with GNR and GPC meningitis. CSF cultures positive with coagulase-negative staphylococci were excluded.

Results:

We identified 77 infants with GNR and 86 with GPC meningitis. There were no differences in gestational age, birth weight, infant sex, race, or rate of Caesarean section. GNR meningitis was more often diagnosed after the third postnatal day and was associated with higher white blood cell and red blood cell counts. GNR meningitis diagnosed in the first 3 days of life was associated with antepartum antibiotic exposure. No difference was noted in either CSF protein or glucose levels. After correcting for gestational age, there was no observed difference in mortality between infants infected with GNR or GPC.

Conclusion:

Compared to GPC meningitis, GNR meningitis was associated with several aspects of the clinical history and laboratory findings including older age of presentation, antepartum exposure to antibiotics, and elevated CSF white blood cell and red blood cell counts.

This is a preview of subscription content, access via your institution

Access options

Buy this article

  • Purchase on Springer Link
  • Instant access to full article PDF
Buy now

Prices may be subject to local taxes which are calculated during checkout

Figure 1
Figure 2

Similar content being viewed by others

References

  1. Klein JO, Feigin RD, McCracken Jr GH . Report of the task force on diagnosis and management of meningitis. Pediatrics 1986; 78: 959–982.

    CAS  PubMed  Google Scholar 

  2. Overall Jr JC . Neonatal bacterial meningitis. Analysis of predisposing factors and outcome compared with matched control subjects. J Pediatr 1970; 76: 499–511.

    Article  Google Scholar 

  3. Towers CV, Carr MH, Padilla G, Asrat T . Potential consequences of widespread antepartal use of ampicillin. Am J Obstet Gynecol 1998; 179: 879–883.

    Article  CAS  Google Scholar 

  4. Byington CL, Rittichier KK, Bassett KE, Castillo H, Glasgow TS, Daly J et al. Serious bacterial infections in febrile infants younger than 90 days of age: the importance of ampicillin-resistant pathogens. Pediatrics 2003; 111: 964–968.

    Article  Google Scholar 

  5. McDuffie Jr RS, McGregor JA, Gibbs RS . Adverse perinatal outcome and resistant Enterobacteriaceae after antibiotic usage for premature rupture of the membranes and group B streptococcus carriage. Obstet Gynecol 1993; 82: 487–489.

    PubMed  Google Scholar 

  6. Hervas JA, Ballesteros F, Alomar A, Gil J, Benedi VJ, Alberti S . Increase of Enterobacter in neonatal sepsis: a twenty-two-year study. Pediatr Infect Dis J 2001; 20: 134–140.

    Article  CAS  Google Scholar 

  7. Stoll BJ, Hansen N, Fanaroff AA, Wright LL, Carlo WA, Ehrenkranz RA et al. Changes in pathogens causing early-onset sepsis in very-low-birth-weight infants. N Engl J Med 2002; 347: 240–247.

    Article  Google Scholar 

  8. Kanegaye JT, Soliemanzadeh P, Bradley JS . Lumbar puncture in pediatric bacterial meningitis: defining the time interval for recovery of cerebrospinal fluid pathogens after parenteral antibiotic pretreatment. Pediatrics 2001; 108: 1169–1174.

    CAS  PubMed  Google Scholar 

  9. Riordan FA, Cant AJ . When to do a lumbar puncture. Arch Dis Child 2002; 87: 235–237.

    Article  CAS  Google Scholar 

  10. Garges HP, Moody MA, Cotten CM, Smith PB, Tiffany K, Lenfesty R et al. Diagnosis of neonatal meningitis: the lumbar puncture, the blood culture and CSF parameters. Pediatrics (in publication) 2005.

  11. Stoll BJ, Hansen N, Fanaroff AA, Wright LL, Carlo WA, Ehrenkranz RA et al. To tap or not to tap: high likelihood of meningitis without sepsis among very low birth weight infants. Pediatrics 2004; 113: 1181–1186.

    Article  Google Scholar 

  12. Sarff LD, Platt LH, McCracken Jr GH . Cerebrospinal fluid evaluation in neonates: comparison of high-risk infants with and without meningitis. J Pediatr 1976; 88: 473–477.

    Article  CAS  Google Scholar 

  13. Bonadio WA, Stanco L, Bruce R, Barry D, Smith D . Reference values of normal cerebrospinal fluid composition in infants ages 0 to 8 weeks. Pediatr Infect Dis J 1992; 11: 589–591.

    Article  CAS  Google Scholar 

  14. Mangi RJ, Quintiliani R, Andriole VT . Gram-negative bacillary meningitis. Am J Med 1975; 59: 829–836.

    Article  CAS  Google Scholar 

  15. Unhanand M, Mustafa MM, McCracken Jr GH, Nelson JD . Gram-negative enteric bacillary meningitis: a twenty-one-year experience. J Pediatr 1993; 122: 15–21.

    Article  CAS  Google Scholar 

  16. Sarman G, Moise AA, Edwards MS . Meningeal inflammation in neonatal Gram-negative bacteremia. Pediatr Infect Dis J 1995; 14: 701–704.

    Article  CAS  Google Scholar 

  17. Thorp JA, Jones PG, Peabody JL, Knox E, Clark RH . Effect of antenatal and postnatal corticosteroid therapy on weight gain and head circumference growth in the nursery. Obstet Gynecol 2002; 99: 109–115.

    CAS  PubMed  Google Scholar 

  18. Feigin RD, Cherry JD, Demmler GJ, Kaplan SL . Textbook of Pediatric Infectious Diseases. 5th edition. Philadelphia, PA: WB Saunder Co; 2004, pp 945–948.

    Google Scholar 

  19. Schwersenski J, McIntyre L, Bauer CR . Lumbar puncture frequency and cerebrospinal fluid analysis in the neonate. Am J Dis Child 1991; 145: 54–58.

    CAS  PubMed  Google Scholar 

  20. Mulder CJ, van Alphen L, Zanen HC . Neonatal meningitis caused by Escherichia coli in The Netherlands. J Infect Dis 1984; 150: 935–940.

    Article  CAS  Google Scholar 

  21. Wiswell TE, Baumgart S, Gannon CM, Spitzer AR . No lumbar puncture in the evaluation for early neonatal sepsis: will meningitis be missed? Pediatrics 1995; 95: 803–806.

    CAS  PubMed  Google Scholar 

  22. Benjamin DK, DeLong E, Cotten CM, Garges HP, Steinbach WJ, Clark RH . Mortality following blood culture in premature infants: increased with Gram-negative bacteremia and candidemia, but not Gram-positive bacteremia. J Perinatol 2004; 24: 175–180.

    Article  Google Scholar 

  23. Stoll BJ, Hansen N, Fanaroff AA, Wright LL, Carlo WA, Ehrenkranz RA et al. Late-onset sepsis in very low birth weight neonates: the experience of the NICHD Neonatal Research Network. Pediatrics 2002; 110: 285–291.

    Article  Google Scholar 

  24. Shah SS, Ehrenkranz RA, Gallagher PG . Increasing incidence of Gram-negative rod bacteremia in a newborn intensive care unit. Pediatr Infect Dis J 1999; 18: 591–595.

    Article  CAS  Google Scholar 

  25. Terrone DA, Rinehart BK, Einstein MH, Britt LB, Martin Jr JN, Perry KG . Neonatal sepsis and death caused by resistant Escherichia coli: possible consequences of extended maternal ampicillin administration. Am J Obstet Gynecol 1999; 180: 1345–1348.

    Article  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Pediatrics, Duke University, Durham, NC, USA

    P B Smith, C M Cotten, H P Garges, K F Tiffany, R W Lenfestey, M A Moody, J S Li & D K Benjamin Jr

  2. Duke University Clinical Research Institute, Durham, NC, USA

    P B Smith, J S Li & D K Benjamin Jr

Authors
  1. P B Smith
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. C M Cotten
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. H P Garges
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. K F Tiffany
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. R W Lenfestey
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. M A Moody
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. J S Li
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. D K Benjamin Jr
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to D K Benjamin Jr.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Smith, P., Cotten, C., Garges, H. et al. A comparison of neonatal Gram-negative rod and Gram-positive cocci meningitis. J Perinatol 26, 111–114 (2006). https://doi.org/10.1038/sj.jp.7211438

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1038/sj.jp.7211438

Keywords

This article is cited by

Search

Advanced search

Quick links