{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,3]],"date-time":"2026-06-03T16:16:44Z","timestamp":1780503404260,"version":"3.54.1"},"reference-count":13,"publisher":"MDPI AG","issue":"2","license":[{"start":{"date-parts":[[2021,2,10]],"date-time":"2021-02-10T00:00:00Z","timestamp":1612915200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Children"],"abstract":"<jats:p>Relapse of neonatal meningitis is most commonly caused by Escherichia coli. Management to prevent relapse varies and evidence is limited. We present four cases of relapsing neonatal E. coli meningitis in Denmark in 2016\u20132017 and review the current literature on this subject. During the primary episodes, our patients received cephalosporin for 3 weeks and gentamicin for the first 3 days. The only identified risk factor was delayed CSF sterilization in three of four cases and no repeated lumbar puncture. Relapse occurred after 2\u201328 days; one case with ventriculitis and one with empyema. Relapses were treated for 6\u201314 weeks with monotherapy. No children had an underlying disease predisposing to E. coli meningitis. There is generally a trend towards reducing invasive procedures, e.g., lumbar puncture and the length of intravenous antibiotics in pediatric infectious diseases, but our cases highlight a condition where the opposite might be needed.<\/jats:p>","DOI":"10.3390\/children8020126","type":"journal-article","created":{"date-parts":[[2021,2,12]],"date-time":"2021-02-12T00:49:26Z","timestamp":1613090966000},"page":"126","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":12,"title":["Relapse of Neonatal Escherichia coli Meningitis: Did We Miss Something at First?"],"prefix":"10.3390","volume":"8","author":[{"given":"Nadja H.","family":"Vissing","sequence":"first","affiliation":[{"name":"Department of Pediatrics and Adolescent Medicine, Copenhagen University Hospital, Rigshospitalet, 2100 Copenhagen, Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mette B.","family":"M\u00f8nster","sequence":"additional","affiliation":[{"name":"Department of Pediatrics and Adolescent Medicine, Copenhagen University Hospital, Rigshospitalet, 2100 Copenhagen, Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sannie","family":"Nordly","sequence":"additional","affiliation":[{"name":"Department of Pediatrics and Adolescence, Copenhagen University Hospital, 2650 Hvidovre, Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gholamreza K.","family":"Dayani","sequence":"additional","affiliation":[{"name":"Department of Pediatrics and Adolescence, Zealand University Hospital, 4000 Roskilde, Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sofie S.","family":"Heedegaard","sequence":"additional","affiliation":[{"name":"Department of Pediatrics and Adolescence, Herning Hospital, 7400 Herning, Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8699-9956","authenticated-orcid":false,"given":"Jenny D.","family":"Knudsen","sequence":"additional","affiliation":[{"name":"Department of Clinical Microbiology, Copenhagen University Hospital, Rigshospitalet, 2100 Copenhagen, Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ulrikka","family":"Nygaard","sequence":"additional","affiliation":[{"name":"Department of Pediatrics and Adolescent Medicine, Copenhagen University Hospital, Rigshospitalet, 2100 Copenhagen, Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2021,2,10]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"212","DOI":"10.1111\/j.1440-1754.1990.tb02432.x","article-title":"Neonatal Gram Negative Meningitis: A 10-Year Review, with Reference to Outcome and Relapse of Infection","volume":"26","author":"Anderson","year":"1990","journal-title":"J. Paediatr. Child Health"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"15","DOI":"10.1016\/S0022-3476(05)83480-8","article-title":"Gram-Negative Enteric Bacillary Meningitis: A Twenty-One-Year Experience","volume":"122","author":"Unhanand","year":"1993","journal-title":"J. Pediatr."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"F173","DOI":"10.1136\/fn.88.3.F173","article-title":"Neonatal Meningitis","volume":"88","author":"Heath","year":"2003","journal-title":"Arch. Dis. Child.-Fetal Neonatal Ed."},{"key":"ref_4","unstructured":"Sarah, S. (2012). Long Principles and Practice of Pediatric Infectious Diseases, Churchill Livingstone. [3rd ed.]."},{"key":"ref_5","unstructured":"National Collaborating Centre for Women\u2019s and Children\u2019s Health (UK) (2010). Bacterial Meningitis and Meningococcal Septicaemia: Management of Bacterial Meningitis and Meningococcal Septicaemia in Children and Young People Younger than 16 Years in Primary and Secondary Care, RCOG Press. National Institute for Health and Clinical Excellence: Guidance."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"451","DOI":"10.1136\/adc.84.5.450d","article-title":"Should Repeat Lumbar Punctures Be Routinely Done in Neonates with Bacterial Meningitis? Results of a Survey into Clinical Practice","volume":"84","author":"Agarwal","year":"2001","journal-title":"Arch. Dis. Child."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"425","DOI":"10.1038\/jp.2010.142","article-title":"Repeat Lumbar Punctures in Infants with Meningitis in the Neonatal Intensive Care Unit","volume":"31","author":"Greenberg","year":"2011","journal-title":"J. Perinatol."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"779","DOI":"10.1093\/cid\/civ367","article-title":"Escherichia Coli Meningitis Features in 325 Children From 2001 to 2013 in France","volume":"61","author":"Basmaci","year":"2015","journal-title":"Clin. Infect. Dis. Off. Publ. Infect. Dis. Soc. Am."},{"key":"ref_9","doi-asserted-by":"crossref","unstructured":"Ouchenir, L., Renaud, C., Khan, S., Bitnun, A., Boisvert, A.-A., McDonald, J., Bowes, J., Brophy, J., Barton, M., and Ting, J. (2017). The Epidemiology, Management, and Outcomes of Bacterial Meningitis in Infants. Pediatrics, 140.","DOI":"10.1542\/peds.2017-0476"},{"key":"ref_10","doi-asserted-by":"crossref","unstructured":"Tauzin, M., Ouldali, N., L\u00e9vy, C., B\u00e9chet, S., Cohen, R., and Caeymaex, L. (2018). Combination Therapy with Ciprofloxacin and Third-Generation Cephalosporin versus Third-Generation Cephalosporin Monotherapy in Escherichia Coli Meningitis in Infants: A Multicentre Propensity Score-Matched Observational Study. Clin. Microbiol. Infect. Off. Publ. Eur. Soc. Clin. Microbiol. Infect. Dis.","DOI":"10.1016\/j.cmi.2018.12.026"},{"key":"ref_11","first-page":"CD012272","article-title":"Newborn Screening for Galactosaemia","volume":"6","author":"Lak","year":"2020","journal-title":"Cochrane Database Syst. Rev."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"188","DOI":"10.1542\/peds.67.2.188","article-title":"Recrudescence and Relapse in Bacterial Meningitis of Childhood","volume":"67","author":"Schaad","year":"1981","journal-title":"Pediatrics"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"519","DOI":"10.1128\/CMR.00009-08","article-title":"Epidemiology, Etiology, Pathogenesis, and Diagnosis of Recurrent Bacterial Meningitis","volume":"21","author":"Tebruegge","year":"2008","journal-title":"Clin. Microbiol. 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