Neonatal Staphylococcus epidermidis Meningitis With Unremarkable CSF Examination Results

• We identified 10 infants (mean±SD birth weight, 1000±500 g; gestation, 29±3 weeks; postnatal age, 24±19 days) who had Staphylococcus epidermidis meningitis despite unremarkable cerebrospinal fluid (CSF) blood cell counts and glucose and protein levels. Staphylococcus epidermidis meningitis was diagnosed if all the following criteria were satisfied: (1) a CSF culture positive for S epidermidis within 48 hours, (2) a blood culture positive for S epidermidis with antibiotic sensitivities identical to those of the CSF isolate, and (3) clinical symptomatology. Lumbar puncture yielded white blood cell counts lower than 10×10⁶/L in 8 infants. Two subjects had CSF white blood cell counts of 11 × 10⁶/L and 14×10⁶/L. Cerebrospinal fluid glucose (2.8±0.9 mmol/L) and protein (1.15 ± 0.32 g/L) concentrations were also unremarkable. Infants were treated with parenteral antibiotics for 19±5 days. There was no mortality or short-term morbidity. Staphylococcus epidermidis is a recognized cause of nosocomial meningitis in low-birth-weight infants and frequently occurs without CSF abnormalities.

(AJDC. 1989;143:580-582)