CLINICAL NOTES

Bacteroides fragilis is a rare cause of bacterial meningitis. In the antibiotic era nine cases have been reported. Seven of these nine cases occurred in premature infants and neo-nates. Of the nine patients with B.fragilis meningitis, two died, four survived with neuro-logic sequelae, and three survived without sequelae. Predisposing conditions included ab-dominal sepsis, chronic otitis media, and ventriculoatrial shunt infection. Metronidazole, which is bactericidal, has been the most effective therapy for B. fragilis meningitis. Bacteroides fragilis is part of the normal flora of the colon and is a common pathogen in abdominal in-fections [1, 2]. Meningitis due to B. fragilis is rare, occurring mostly in premature infants and neonates as a complication of abdominal sepsis [3-6]. B. fra-gills meningitis has also been reported as a compli-cation of chronic otitis media in both children [7] and adults [8]. A case of B. fragilis meningitis in a premature infant with necrotizing enterocolitis is reported herein, and other cases of B fragilismenin-gitis are reviewed. Case Report A 1,390-g female infant was born at 32 weeks of gestation by spontaneous vaginal delivery. Physical examination revealed that this premature infant was in no distress and that her weight was appropriate for her gestational age. Because of maternal fever, the infant's blood, urine, and CSF were cultured to rule out sepsis. The patient's chest radiograph and the results of a complete blood count were normal. Therapy for possible neonatal sepsis was initiated with ampicillin, oxacillin, and tobramycin. On day 4, because cultures were negative, antibi-otics were discontinued and feeding was begun. On day 6 the patient stopped feeding and became irrita-ble. Physical examination revealed abdominal dis-Received for publication August 11,1986, and in revised for