For a suspected case of neonatal meningitis, which bacteria would be a primary concern?

In the context of suspected neonatal meningitis, E. coli is indeed a primary concern. This is due to its prevalence as a causative agent in this age group, particularly among neonates. E. coli, especially the K1 serotype, is associated with serious infections such as meningitis and sepsis in newborns.

Newborns have immature immune systems, making them particularly vulnerable to infections from bacteria that are typically found in the gastrointestinal tract, like E. coli. Additionally, maternal transmission during delivery can expose the infant to pathogens, and E. coli can be part of the normal flora in the mother’s gastrointestinal tract.

While other bacteria listed can cause meningitis, they are less common in neonates. Streptococcus pneumoniae and Neisseria meningitidis are more frequently associated with meningitis in older children and adults. Staphylococcus epidermidis is usually a skin commensal and is less of a concern for meningitis unless there's a breach in the skin barrier, such as in the case of medical devices.

Thus, when assessing the risk of neonatal meningitis, E. coli stands out as a significant pathogen requiring immediate concern and intervention.