Epidemiology and Characteristics of Bacterial Meningitis of Children with Cerebrospinal Fluid Leakage or Cochlear Implant.

BACKGROUND

Cerebrospinal fluid (CSF) leakage is a recognized risk factor for bacterial meningitis. Few data are published concerning bacterial meningitis in children with CSF leakage, and the impact of 13 valent pneumococcal conjugate vaccination (PCV13) in this population is not well known. The aim of this study was to describe the epidemiology of bacterial meningitis in children with known CSF leakage.

METHODS

Among all bacterial meningitis in children >3 months old, we analyzed those with known CSF leakage (meningeal breach and/or cochlear implant resulting in meningitis) in a nationwide prospective cohort between 2001 and 2024 in France, with 227 pediatric wards and 168 microbiology departments.

RESULTS

Of 5879 cases of bacterial meningitis in children over 3 months old, 251 (4.3%) were associated with known CSF leakage. In this population, Streptococcus pneumoniae (78.9%) was the most frequent bacteria involved, followed by Haemophilus influenzae (10%), mainly non typeable strains. Two cases of Neisseria meningitidis were recorded and only in children with cochlear implant. For children with known CSF leakage, in late PCV13 period, PCV13, PCV15, PCV20, PCV21, and 23-valent polysaccharide vaccine serotypes accounted for 14%, 16.3%, 37.2%, 79.1%, and 27.9%, respectively. In this population, serotype 23B was the most frequent (18.6%), followed by 11A (9.3%), 15A (9.3%), 19F (7%), 3 (4.7%), and 19A (2.3%).

CONCLUSION

Bacterial meningitis in children with known CSF leakage is largely due to pneumococci and now mainly due to serotypes not included in PCV13. Only two cases of meningococcal meningitis were found and only for children with cochlear implant.