Microbiota composition might play a role in the pathophysiology and course of sepsis, and understanding its dynamics is of clinical interest. Invasive meningococcal disease (IMD) is an important cause of community-acquired serious infection, and there is no information regarding microbiota composition in children with meningococcemia. In this study, we aimed to evaluate the intestinal and nasopharyngeal microbiota composition of children with IMD.Materials and Methods:In this prospective, multi-center study, 10 children with meningococcemia and 10 age-matched healthy controls were included. Nasopharyngeal and fecal samples were obtained at admission to the intensive care unit and on the tenth day of their hospital stay. The V3 and V4 regions of the 16S rRNA gene were amplified following the 16S Metagenomic Sequencing Library Preparation.Results:Regarding the alpha diversity on the day of admission and on the tenth day at the PICU, the Shannon index was significantly lower in the IMD group compared to the control group (p= 0.002 at admission andp= 0.001, on the tenth day of PICU). A statistical difference in the stool samples was found between the IMD group at Day 0 vs. the controls in the results of the Bray–Curtis and Jaccard analyses (p= 0.005 andp= 0.001, respectively). There were differences in the intestinal microbiota composition between the children with IMD at admission and Day 10 and the healthy controls. Regarding the nasopharyngeal microbiota analysis, in the children with IMD at admission, at the genus level,Neisseriawas significantly more abundant compared to the healthy children (p< 0.001). In the children with IMD at Day 10, generaMoraxellaandNeisseriawere decreased compared to the healthy children. In the children with IMD on Day 0, for paired samples,Moraxella,Neisseria, andHaemophiluswere significantly more abundant compared to the children with IMD at Day 10. In the children with IMD at Day 10, theMoraxellaandNeisseriagenera were decreased, and 20 different genera were more abundant compared to Day 0.Conclusions:We first found alterations in the intestinal and nasopharyngeal microbiota composition in the children with IMD. The infection itself or the other care interventions also caused changes to the microbiota composition during the follow-up period. Understanding the interaction of microbiota with pathogens, e.g.,N. meningitidis, could give us the opportunity to understand the disease’s dynamics.