1173. Paediatric Investigators Collaborative Network on Infections in Canada (PICNIC) study of the epidemiology of bacterial and fungal meningitis in infants aged < 90 days.
Session: Poster Abstract Session: Clinical Infectious Diseases: CNS Infection
Friday, October 28, 2016
Room: Poster Hall
  • IMG_0068.PNG (293.0 kB)
  • Background:

    Bacterial and fungal meningitis remain a cause of mortality and morbidity in young infants. There is a paucity of information on bacterial meningitis in North America in the era of infant pneumococcal vaccine and intra-partum group B streptococcus (GBS) prophylaxis.


    A retrospective chart review for all newborns from 0 to 90 days of age was performed in 8 centers across Canada for the years 2013 and 2014 to describe the etiology and outcome of bacterial and fungal meningitis. Cases were identified through search of ICD-10 codes.


    A total of 113 cases of bacterial meningitis and one case of Candidal meningitis were identified. 64 were proven cases with bacteria or fungi identified in CSF and 50 were suspected cases, with CSF pleocytosis and bacteria identified at another sterile site. Pathogens were Escherichia Coli (E.coli) (37/114 [32.5%]) GBS (35/114 [30.7%]) and other gram negative and positive bacteria (29/114 [25.4%]). The remaining cases were divided between N. Meningitidis (N=4), Hemophilus influenzae type B (Hib) (N=3), Listeria (N=3) and Streptococcus pneumoniae (N=1). Seventeen cases (14.9%) of early-onset (day 0-6) meningitis, 63 (55.2%) of late-onset (day 7-29) and 34 (29.8%) of very late-onset (day 30-89) were identified. Amongst the early-onset cases GBS was the leading cause (8/17[47.4%])cases and E.coli represented 4 cases (23.5%). The Candidal meningitis and one case of Hib were amongst the early-onset. In the late onset cases, the leading cause was E.coli (24/63 [38.1%]) followed by other bacteria (19/63[30.2%]) and GBS (16/63 [25.4%]). The remaining late-onset were Listeria (N=3) and N.meningitidis (N=1). GBS predominated in the very late-onset category (11/34 [32.4%]) followed by E.coli (9/34 [25.7%]) and other bacteria (8/34 [23.5%]). In the remaining very late-onset cases were Neisseria meningitis (N=3), Hib (N=2) and Streptococcus pneumoniae (N=1). The case fatality rate was 6% (7/114) cases. 39 patients (34.2%) had seizures after onset of CNS symptoms, 22 (19.3%) patients developed hydrocephalus of which 14 (12.3%) required CSF shunts.


    GBS and E.coli remain the two leading causes of bacterial meningitis amongst neonates in Canada. The case fatality rate and morbidity remain significant and warrant the need for development of new strategies to prevent both early and late onset GBS meningitis.

    Lynda Ouchenir, MD1, Christian Renaud, MD, MSc, FRCPC2, Ari Bitnun, MD, MSc3, Sarah Khan, MD, FRCPC4, Michelle Barton, MBBS5, Jason C. Brophy, MD, MSc, DTM6, Jennifer Bowes, M Sc7, Jane Mcdonald, MD8, André-Anne Boisvert, MD9, Ashley Roberts, MD, M.Ed., FRCPC10, Joseph Ting, MBBS, FRCPC, MPH10, Joan Robinson, MD11 and PICNIC, (1)Pediatrics, CHU Sainte-Justine, Montreal, QC, Canada, (2)Microbiology and Infectious Diseases, CHU Sainte-Justine, Université de Montréal, Montréal, QC, Canada, (3)The Hospital for Sick Children, Toronto, ON, Canada, (4)Pediatrics, The Hospital for Sick Children, Toronto, ON, Canada, (5)Hospital for Sick Children, Toronto, ON, Canada, (6)Children's Hospital of Eastern Ontario, University of Ottawa, Ottawa, ON, Canada, (7)Infectious Diseases, Children's Hospital of Eastern Ontario, Ottawa, ON, Canada, (8)Mcgill University, Montreal, QC, Canada, (9)MCUH, Montreal, QC, Canada, (10)Pediatrics, University of British Columbia, Vancouver, BC, Canada, (11)University of Alberta, Edmonton, AB, Canada


    L. Ouchenir, None

    C. Renaud, None

    A. Bitnun, None

    S. Khan, None

    M. Barton, None

    J. C. Brophy, None

    J. Bowes, None

    J. Mcdonald, None

    A. A. Boisvert, None

    A. Roberts, None

    J. Ting, None

    J. Robinson, None

    Findings in the abstracts are embargoed until 12:01 a.m. CDT, Wednesday Oct. 26th with the exception of research findings presented at the IDWeek press conferences.