Incidence of meningitis in blood culture proven neonatal sepsis in a pediatric tertiary care hospital in Bangalore
Abstract
Objectives: Neonatal bacterial meningitis continues to be an important cause of mortality and morbidity. Contributing factors to such mortality and morbidity include our incomplete knowledge on the pathogenesis of how meningitis-causing bacteria penetrate the blood brain barrier, emergence of antimicrobial resistance, and difficulty in early diagnosis of meningitis. An early empiric antibiotic treatment is critical for the management of neonates with bacterial meningitis, but early recognition of neonatal meningitis continues to be a challenge. The concordance between blood, and CSF cultures may affect management strategies for sepsis and meningitis so this study was carried out.
Materials and Methods: This is a retrospective study done over a period of 12 months from January 2016 to December 2016. Blood culture results were compared with results of CSF cultures and CSF parameters like white blood cells, glucose, and protein to establish the concordance of these values in culture-proven meningitis.
Results: Out of 616 CSF cultures sent, culture positives were seen in 47 (7.6%) neonates. Of the 47 patients with meningitis, 40(85.1%) had a documented blood culture and 7(14.8%) was contaminants. In neonates with both positive blood and CSF cultures, the organisms isolated were discordant in 2 (4.2%) of 40 cases. The common organisms isolated was Group B streptococci 14(29%), Escherichia coli 10(21%), followed by CONS 7(14.8%), staphylococcus aureus 7(14.8%) and Klebsiella species 2(4.2%).
Conclusion: In this study Neonatal meningitis frequently occurs in the absence of bacteremia and in the presence of normal CSF parameters. No single CSF value can reliably exclude the presence of meningitis in neonates. The CSF culture is critical to establishing the diagnosis of neonatal meningitis.
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References
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