Mauricio López, Karina Godoy Tamayo
This registration covers the protocol for a scoping review of neonatal central nervous system (CNS) infection attributable to Serratia marcescens, including meningitis, ventriculitis, and cerebral abscess. S. marcescens is an opportunistic Gram-negative organism and an established cause of healthcare-associated infection and outbreaks in neonatal intensive care units, particularly among very preterm infants and those requiring prolonged hospitalization. Its basal chromosomal AmpC beta-lactamase confers intrinsic resistance to ampicillin, amoxicillin-clavulanate, and first- and second-generation cephalosporins, so an initial empirical regimen may lack in vitro activity against the infecting strain; treatment failure, however, should not be presumed from species identification alone. Reported intracranial complications include ventriculitis, cerebral abscess, hydrocephalus, and destructive parenchymal lesions. Arterial ischemic stroke and cerebral sinovenous thrombosis are recognized complications of neonatal bacterial meningitis more broadly, but direct evidence specific to this organism is limited. The relevant evidence is dispersed across case reports, small series, outbreak investigations, and retrospective cohorts that differ in their definitions of meningitis and treatment failure, in documentation of empirical antimicrobial activity and treatment timing, and in use of serial neuroimaging and outcome reporting. The purpose of this review is to map that evidence. It will characterize the initial empirical regimen and its isolate-specific in vitro activity; the intervals from empirical treatment initiation to microbiologic identification, availability of susceptibility results, the first isolate-active systemic dose, and documented meningitis-directed active therapy; indicators of treatment nonresponse; definitive and adjunctive treatment; serial neuroimaging findings; ischemic stroke and other intracranial complications; and neurologic and neurodevelopmental outcomes. A preliminary search conducted on June 19, 2026, identified no existing systematic or scoping review addressing these questions. The review will follow JBI methodology and will be reported according to PRISMA-ScR and PRISMA-S. Eligible participants are neonates from birth through 28 completed postnatal days at infection onset, and preterm infants with infection arising during continuous hospitalization from birth when onset occurs before 44 weeks' postmenstrual age. Only primary clinical reports providing patient-level or separately extractable neonatal data will be included; confirmed and probable CNS infections will be classified and presented separately. Searches will be conducted from database inception to the date of the search in MEDLINE via PubMed, Scopus, Web of Science, Global Index Medicus, CENTRAL via the Cochrane Library, and Europe PMC preprints, supplemented by prespecified Google Scholar and citation searching, without date or language restrictions. Two reviewers will independently screen records, assess reports, and chart data using a piloted relational instrument that separates data as reported from reviewer-derived classifications. Expected outputs include descriptive tables of report and patient characteristics, antimicrobial treatment with susceptibility findings and treatment intervals, nonresponse indicators, neuroimaging findings and intracranial complications, and survival and neurodevelopmental outcomes; patient-level clinical timelines and, where informative, an evidence map relating treatment to neurologic findings; and an explicit account of reporting limitations and evidence gaps in diagnostic confirmation, susceptibility reporting, treatment timing, neuroimaging surveillance, and longitudinal follow-up. No formal critical appraisal and no meta-analysis are planned; temporal associations will be described without inferring causation, and conclusions will remain proportionate to descriptive evidence.