Meningitis and shunt infection caused by anaerobic bacteria in children.

This review describes the microbiology and management of meningitis and shunt infections caused by anaerobic bacteria in children. The predominant anaerobes recovered in meningitis are Bacteriodes spp., Bacteriodes fragilis, Fusobacterium spp., and Clostridium spp. Peptostreptococcus, Veillonella, Actinomyces, Propionibacterium acnes, and Eubacterium are less commonly isolated. The predisposing conditions for meningitis are acute or chronic middle-ear infection, sinusitis, pharyngitis, and pulmonary infections. In newborn and preterm infants the predisposing conditions are rupture of membranes, amnionitis, fetal distress, necrotizing enterocolitis, gastric perforation and subsequent ileus followed by bacteremia, aspiration pneumonitis and septicemia, infected ventriculoperitoneal or ventriculoatrial shunt, and complicating dermal sinus tract infections. Shunt infection with Propionibacterium spp. has been reported in children, especially in association with ventriculoauricular and ventriculoperitoneal shunts. Clostridium perfringens has been recovered from infants with a ventriculoperitoneal shunt. Multiple-organism meningitis was reported as a complication of ventriculoperitoneal and lumboperitoneal shunts that perforated the gastrointestinal tract. Early recognition and effective therapy are essential to recovery. Management of meningitis includes the use of antimicrobials effective against anaerobes that penetrate the blood-brain barrier. These include metronidazole, chloramphenicol, the combination of a penicillin and a beta-lactamase inhibitor, and carbapenems. The treatment of shunt infection includes antimicrobial therapy and removal of the shunt.