Etiology and Laboratory Abnormalities in Bacterial Meningitis in Neonates and Young Infants

Kotzbauer, David; Travers, Curtis; Shapiro, Craig; Charbonnet, Margaux; Cooley, Anthony; Andresen, Deborah; Frank, Gary

doi:10.4081/cp.2017.943

Cited by 5 publications

(6 citation statements)

References 20 publications

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“…In the present study, GBS was found high in infants with suspected meningitis cases, 63.9% (46/72), which is quite comparable with the study done in Korea 69% [15] and lower the USA 86.1% [16]. The finding was higher relative to the study carried out in China (46.5%) [17], in USA (53.6%) [18], in England (52%) [19], in South Africa (44%) [20] and in Malawi (26.3%) [8]. The difference observed may be due to the detection method utilized, maternal use of intra partum antibiotic prophylaxis (IAP), study setting differences, or population variations.…”

Section: Discussionsupporting

confidence: 84%

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Enhanced identification of Group B streptococcus in infants with suspected meningitis in Ethiopia

et al. 2020

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Meningitis is one of the top ten causes of death among Ethiopian infants. Group B streptococcus (GBS) has emerged as a leading cause of meningitis in neonates and young infants, resulting in high mortality. Despite this, there is no report on GBS associated meningitis in Ethiopia where infant meningitis is common. Hence, the aim of this study was to determine the proportion of GBS associated meningitis among Ethiopian infants. PCR was prospectively used to detect GBS in culture-negative cerebrospinal fluid (CSF) samples, which were collected from infants suspected for meningitis, at Tikur Anbessa specialized hospital, Ethiopia, over a one-year period. GBS was detected by PCR in 63.9% of culture-negative CSF samples. Out of the 46 GBS positive infants, 10.9% (n = 5) of them died. The late onset of GBS (LOGBS) disease was noted to have a poor outcome with 3 LOGBS out of 5 GBS positive samples collected from patients with the final outcome of death. PCR was advantageous in the identification of GBS in culture-negative CSF samples. GBS was detected in 64% of the CSF samples from infants with meningitis compared with zero-detection rate by culture.

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Section: Discussionsupporting

confidence: 84%

“…Opposing this conclusion, the present study found more than 67% of infants positive for GBS had WCC < 20 cells/ μl. A similar study in India has also described that 16% of infants with GBS had 0–20 cells/ul [ 31 ], and in the USA nearly 11% of cases lacked CSF pleocytosis [ 18 ].…”

Section: Discussionmentioning

confidence: 99%

Enhanced identification of Group B streptococcus in infants with suspected meningitis in Ethiopia

et al. 2020

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“…agalactiae was the predominant pathogen, however, this was in a small population of 56 volunteers and retrospective analyses may have questionable validity. [ 83 ] An additional analysis was carried out in our study for data in neonates on the frequency of group B S . agalactiae for all regions and found that the frequency was highest in the European region (but limited to one study only [ 84 ]), and lowest in the Eastern Mediterranean region (based on two studies only [ 34 , 85 ]).…”

Section: Resultsmentioning

confidence: 99%

Global etiology of bacterial meningitis: A systematic review and meta-analysis

Oordt-Speets¹,

Bolijn²,

Hoorn³

et al. 2018

PLoS ONE

182

157

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Bacterial meningitis is a global public health concern, with several responsible etiologic agents that vary by age group and geographical area. The aim of this systematic review and meta-analysis was to assess the etiology of bacterial meningitis in different age groups across global regions. PubMed and EMBASE were systematically searched for English language studies on bacterial meningitis, limited to articles published in the last five years. The methodological quality of the studies was assessed using a customized scoring system. Meta-analyses were conducted to determine the frequency (percentages) of seven bacterial types known to cause meningitis: Escherichia coli, Haemophilus influenzae, Neisseria meningitidis, Streptococcus pneumoniae, group B Streptococcus agalactiae, Staphylococcus aureus, and Listeria monocytogenes, with results being stratified by six geographical regions as determined by the World Health Organization, and seven age groups.Of the 3227 studies retrieved, 56 were eligible for the final analysis. In all age groups, S. pneumoniae and N. meningitidis were the predominant pathogens in all regions, accounting for 25.1–41.2% and 9.1–36.2% of bacterial meningitis cases, respectively. S. pneumoniae infection was the most common cause of bacterial meningitis in the ‘all children’ group, ranging from 22.5% (Europe) to 41.1% (Africa), and in all adults ranging from 9.6% (Western Pacific) to 75.2% (Africa). E. coli and S. pneumoniae were the most common pathogens that caused bacterial meningitis in neonates in Africa (17.7% and 20.4%, respectively). N. meningitidis was the most common in children aged ±1–5 years in Europe (47.0%). Due to paucity of data, meta-analyses could not be performed in all age groups for all regions.A clear difference in the weighted frequency of bacterial meningitis cases caused by the different etiological agents was observed between age groups and between geographic regions. These findings may facilitate bacterial meningitis prevention and treatment strategies.

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“…Most of this research has focused on clinical appearance in terms of the presence or absence of bacterial infections, and much less on clinical outcomes. The majority of these studies have demonstrated a significant association between ill appearance and bacterial infections,(9, 28, 30–32, 34, 36–38) yet some have called into question the reliability of either objective or subjective determinations of ill appearance in identifying infants with IBI. (39, 40) Although important to note that our cohort excludes infants with suspected IBI whose cultures are negative, our data nonetheless identify ill appearance at presentation as a poor prognostic indicator when IBI is present.…”

Section: Discussionmentioning

confidence: 99%

“…We sought to mitigate this limitation by utilizing a specific, previously published list of complex chronic conditions. (23) Though we used an established definition of ill appearance with high inter-rater reliability(24) that is more rigorous than those used in many previous studies,(30, 36–38) this method of classification may not accurately reflect clinical appearance on arrival to the ED for infants with suspected IBI. We also classified 10 infants with bacteremia and CSF pleocytosis (but with negative CSF cultures) as having bacterial meningitis if antimicrobial therapy was administered prior to CSF collection.…”

Section: Discussionmentioning

confidence: 99%

Factors Associated with Adverse Outcomes among Febrile Young Infants with Invasive Bacterial Infections

Pruitt

Neuman

Shah

et al. 2019

The Journal of Pediatrics

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Objective To determine factors associated with adverse outcomes among febrile young infants with invasive bacterial infections (IBI), i.e., bacteremia and/or bacterial meningitis. Study design Multicenter, retrospective cohort study (July 2011 – June 2016) of febrile infants ≤60 days of age with pathogenic bacterial growth in blood and/or cerebrospinal fluid. Subjects were identified by query of local microbiology laboratory and/or electronic medical record systems, and clinical data were extracted by medical record review. Mixed-effect logistic regression was employed to determine clinical factors associated with 30-day adverse outcomes, which were defined as death, neurologic sequelae, mechanical ventilation, or vasoactive medication receipt. Results 350 infants met inclusion criteria; 279 (79.7%) with bacteremia without meningitis and 71(20.3%) with bacterial meningitis. Forty-two (12.0%) infants had a 30-day adverse outcome: 29/71 (40.8%) with bacterial meningitis vs. 13/279 (4.7%) with bacteremia without meningitis (36.2% difference, 95% CI 25.1% to 48.0%; P < .001). On adjusted analysis, bacterial meningitis (adjusted odds ratio [aOR] 16.3, 95% CI 6.5 to 41.0; P<0.001), prematurity (aOR 7.1, 95% CI2.6 to 19.7; P<0.001), and ill appearance (aOR 3.8, 95% CI 1.6 to 9.1; P=0.002) were associated with adverse outcomes. Among infants who were born at term, not ill appearing, and had bacteremia without meningitis, only 2/184 (1.1%) had adverse outcomes, and there were no deaths. Conclusions Among febrile infants ≤60 days old with IBI, prematurity, ill appearance, and bacterial meningitis (vs bacteremia without meningitis) were associated with adverse outcomes. These factors can inform clinical decision-making for febrile young infants with IBI.

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Etiology and Laboratory Abnormalities in Bacterial Meningitis in Neonates and Young Infants

Cited by 5 publications

References 20 publications

Enhanced identification of Group B streptococcus in infants with suspected meningitis in Ethiopia

Enhanced identification of Group B streptococcus in infants with suspected meningitis in Ethiopia

Global etiology of bacterial meningitis: A systematic review and meta-analysis

Factors Associated with Adverse Outcomes among Febrile Young Infants with Invasive Bacterial Infections

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