A retrospective study of 80 infantile patients (ages 30-365 days; 47 male, 33 female) with culture-proven bacterial meningitis seen over a 16 year period (1986-2001) is reported from Taiwan. Two had post-neurosurgical meningitis, 16 were nosocomial cases, and 62 the community-acquired spontaneous form. The most prevalent pathogens were Salmonella species, Streptococcus agalactiae, Escherichia coli, and Haemophilus influenza. Salmonella, E coli and H influenzae occurred more often in older infants, whereas S agalactiae were more prevalent in younger infants. A decrease in Salmonella cases from 27% in the first 8 years of the study to 9% in the second 8 years was accompanied by a proportional increase in E coli meningitis in the second half of the study. Presenting clinical manifestations included fever in 76 patients, disturbed consciousness in 49, seizures in 45, bulging fontanelle in 26, neck stiffness 11, and gastrointestinal disorders 24. Mortality for both periods was 11%, and 43% had poor outcomes. H influenzae, S pneumoniae, and Salmonella species meningitides were complicated by a high prevalence of neurologic disorders (subdural empyema [30], hydrocephalus [25 cases], and cerebral infarctions [7]). Initial changing levels of consciousness were independently associated with treatment failure. Of 42 patients with meningitis caused by Gram-negative bacilli and Hemophilus species, 22 had antibiotic-resistant strains. Combined antibiotic and dexamethasone therapy was used in 14 patients, 9 of whom had a poor outcome. [1]

COMMENT. In the United States the 3 most common causative organisms causing infantile meningitis were H influenzae (64%), S pneumoniae (12%), and N meningitides (11%) (Feigin RD et al. 1992). Since 1988 when Hib conjugate vaccines were introduced, the incidence of Hib disease in infants and young children has declined by 99%. Invasive Hib disease now occurs primarily in underimmunized infants too young to have completed the primary immunization series. (AAP Red Book 2000). The emergence of resistant strains presents a challenge to infectious disease specialists and the choice of optimum antibiotic therapy. Dexamethasone use was not associated with a statistical improvement in outcome in the Taiwan study.