Bacterial meningitis causes significant morbidity and mortality in infants. Lumbar punctures are often deferred until the results of blood cultures are known and sometimes not considered, making this population susceptible to a missed diagnosis. There are few studies describing the epidemiology of neonatal meningitis in quaternary neonatal intensive care unit settings. We describe the epidemiology of meningitis in a level IV neonatal intensive care unit; compare pathogens and rates of concordant bacteremia between infants with and without neurosurgical (NS) devices. Retrospective review of infants < 1 year of age in the Children's Hospital of Philadelphia neonatal intensive care unit with bacterial meningitis (June 2007-October 2021). Analysis included summary statistics, Wilcoxon rank sum, Chi square, and Fisher exact tests. We identified 101 episodes of bacterial meningitis (95 infants). 9 infants died. At diagnosis, 26 infants (27%) had NS devices. Group B streptococcus (GBS) and Escherichia coli (E coli) were most common pathogens, however, coagulase-negative staphylococci and Staphylococcus aureus (S aureus) predominated among infants with NS devices. While 86% had positive blood cultures in the absence of a NS device, only 14% of episodes with NS devices had concomitant bacteremia (P < .0001). Although Group B streptococcus and E coli remain most prevalent overall, coagulase-negative staphylococci and S aureus were common pathogens in NS patients. Infants with NS devices rarely had concomitant bacteremia. Meningitis was diagnosed in the absence of a positive blood culture in 36% of episodes, underscoring the importance of developing guidance for lumbar punctures in infants evaluated for sepsis.
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