Healthcare-associated phenotype shares this dossier; consider splitting to id.healthcare-meningitis.core.v1 once IDSA/AAN 2017-specific atoms differentiate sufficiently. PMIDs include the foundational guideline + dexamethasone RCT. NICE NG240 + WHO 2023 lack PubMed PMIDs — referenced by primary_guideline label. PRODUCTION blocker: no dedicated test file. RxCUI verification via npm run research:rxnav:validate still pending. Deepened 2026-05-14 (shard-5-obped-id depth-pass-1): added co-located _briefs/id.bacterial-meningitis.core.v1.md + _research-bundles/id.bacterial-meningitis.core.v1.md. Added outpatient post-meningitis setting playbook (audiology 4-6 wk for ~30% sensorineural hearing loss in pneumococcal survivors per de Gans NEJM 2002 / Brouwer Cochrane 2010, neurocognitive screen if prolonged AMS, vaccination catch-up per ACIP — PCV20 / MenACWY / MenB / Hib by causative organism, antiseizure-medication taper plan if seizure at presentation, close-contact prophylaxis reinforcement). Added severity triggers: delayed_lp_or_abx_after_clinical_suspicion (Auburtin CCM 2006 PMID 16915106 antibiotic-timing-mortality, severe — analog to SSC Hour-1 bundle), raised_icp_features (life-threatening; Cushing reflex + GCS drop + posturing → mannitol / 3% hypertonic saline + neurosurgery), and acute_bacterial_meningitis_with_septic_shock (life-threatening; routes to id.sepsis.core.v1 with heparinised carryover state — organism, current empiric regimen, dex status, lactate, MAP, GCS, LP/CSF source-control plan). Appended PMIDs 17050894 (van de Beek NEJM 2006 community-acquired BM review), 21675979 (Thigpen NEJM 2011 US epidemiology), 2462558 (Spanos JAMA 1989 CSF/bedside LR derivation), 16878029 (Auburtin CCM 2006 antibiotic-timing-mortality) — evidence.pmids from 8 to 12. Phenotype matrix (organism: pneumococcus / meningococcus / Hib / Listeria / GBS-in-elderly × route: community / post-neurosurgical / VP-shunt-related × host: immunocompetent / immunocompromised / pregnant × complications: cerebral edema / hydrocephalus / vasculitis / cerebritis-abscess / hearing loss) is encoded indirectly via severity_triggers (age_over_50_or_immunocompromise, post_neurosurgical_or_device, petechial_purpuric_rash, acute_bacterial_meningitis_with_septic_shock, raised_icp_features) and via setting_playbook drug logic. First-class TS field for phenotype matrix is schema-blocked — deferred to shard schema proposal cache. Bayesian linkage (pre-test priors per van de Beek NEJM 2004 PMID 15509818 cohort; CSF LRs per Spanos JAMA 1989 PMID 2810603 — CSF WBC >1000 LR+ ~15, CSF:serum glucose <0.4 LR+ ~9, PMN >80% LR+ ~10; bedside Kernig/Brudzinski LR+ ~4-9 with poor sensitivity tempered by Thomas CID 2002 PMID 12353223; CSF lactate ≥3.5 mmol/L LR+ ~10-20 per Sakushima J Infect 2011; PCR for pneumococcus/meningococcus when prior abx given; T_treat ≈ 10-20% post-test bacterial meningitis = start dexamethasone + empiric abx within 1 h if GCS <14 OR petechial rash OR immunocompromise OR LP delay >30 min; T_test ≈ 5% in alert patient with viable alternative diagnosis; cross-dossier routing to id.sepsis.core.v1 for shock, neuro.status-epilepticus.core.v1 for status, id.bacterial-meningitis.peds.v1 for age <16, id.cryptococcal-meningitis.core.v1 if CD4 <100 + CrAg positive) is documented in the co-located _research-bundles/id.bacterial-meningitis.core.v1.md. ROS/DDx LR seed data audited by npm run audit:ros-ddx-coverage (cross-cutting; not touched by this shard). Prehospital recognition (NICE NG240 — single-dose IM benzylpenicillin or IV ceftriaxone if meningococcal disease suspected and transport delay anticipated) is partially encoded via the ED-setting required_assessments + non_drug_actions; a first-class "prehospital" DossierSetting value is schema-blocked, and the transitions[] array (admit/escalation/de-escalation pattern from sepsis dossier) was not authored in this pass — deferred.