Meningeal inflammation in neonatal Gram-negative bacteremia

Şarman, Gülnihal; Moïse, Alicia A.; Edwards, Morven S.

doi:10.1097/00006454-199508000-00011

Cited by 12 publications

(11 citation statements)

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“…It is likely that the presence of bacteria or their products in the CSF is related to the maintenance of the infl ammatory cascade and central nervous system injury. Fifty per cent of the deaths occurred in neonates with a positive culture for enterobacteria, which is supported by other studies that show a variation in mortality according to the type of microorganism isolated from the CSF, with enterobacteria being the most virulent 15,16 . Krebs et al 8 observed signifi cantly higher levels of IL-6 in the CSF of neonates with meningitis due to gram-negative bacteria, suggesting a higher intensity of the infl ammatory process in these newborns.…”

Section: Discussionsupporting

confidence: 77%

“…Treatment of meningitis in the neonatal period is longer than therapy provided to all the other age groups because of the high severity of the disease in the newborn and the elevated risk of recurrence, which might affect 7 to 21% of the cases, even after a full treatment course 15,16 . The authors recommend that the antibiotic therapy is maintained for at least 14 to 21 days after CSF culture becomes negative 12,16 .…”

Section: Discussionmentioning

confidence: 99%

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Clinical outcome of neonatal bacterial meningitis according to birth weight

Krebs¹,

Costa²

2007

Arq. Neuro-Psiquiatr.

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-Objective: To describe the clinical outcome and the complications of bacterial meningitis according to birth weight of out born neonates admitted in intensive care unit during an 11 year-period. Method: Eighty-seven newborns were studied. Thirty-four infants were low birth weight newborn and 53 presented birth weight ≥2500 g. The clinical data were obtained through the analysis of patients' files. Fisher's exact test, the χ 2 and the Mann-Whitney test were applied. Results: Neurological symptoms were more common in infants weighed ≥2500 g (p<0.05). Complications affected half of the cases in both groups. Complications affected half of the cases in both groups, with an overall mortality rate of 11.5%. Conclusion: The rate of complications was high in both groups, regardless of the birth weight. No association was observed between the occurrence of death and birth weight. Infants with positive CSF culture had a poorer prognosis.KEY WORDS: newborn, neonatal meningitis, central nervous system. Evolução clínica da meningite bacteriana neonatal de acordo com o peso de nascimento RESUMO -Objetivo: Descrever a evolução clínica e as complicações da meningite bacteriana de acordo com o peso de nascimento em recém-nascidos admitidos em unidade de terapia intensiva externa durante o período de 11 anos. Método: Foram estudados 87 neonatos, dos quais 34 foram recém-nascidos de baixo peso e 53 apresentaram peso ≥2500 g. Os dados clínicos foram obtidos por análise dos prontuários médicos. Foram realizados teste exato de Fisher, teste do χ 2 e teste de Mann-Whitney. Resultados: Os sintomas neurológi-cos foram mais comuns em neonatos com peso ≥2500 g (p<0,05 ). As complicações ocorreram na metade dos casos em ambos os grupos, com mortalidade global de 11.5%. Conclusão: A freqüência de complicações foi alta em ambos os grupos, independentemente do peso de nascimento. Não houve associação entre óbito e peso de nascimento. Os neonatos com cultura de líquor positiva apresentaram pior prognóstico.PALAVRAS-CHAVE: recém-nascido, meningite neonatal, sistema nervoso central. SP -Brasil. E-mail: verakrebs@uol.com.br Low birth weight newborns present a 3-fold increased risk of acquiring meningitis when compared to those whose birth weight is ≥2500 g 1 . Among very low birth weight neonates (<1500 g) the risk is a 10 to 17-fold higher [2][3][4] . In addition to the immaturity of the immunological system, these neonates frequently present risk factors for infection related to maternal diseases or neonatal conditions 1,3,5 . Dra. Vera Lúcia Jornada Krebs -Rua Iara 123 / 51 -04542-030 São PauloThe objective of this study was to describe the clinical outcome and the complications of bacterial meningitis according to birth weight of out born neonates admitted in intensive care unit during an 11 year-period. METHODEighty-seven newborns with bacterial meningitis who were admitted to the Neonatal Intensive Care Unit (NICU) of the Instituto da Criança, Hospital das Clínicas, University of São Paulo, from January 1 st , 1994 to December ...

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Section: Discussionsupporting

confidence: 77%

Section: Discussionmentioning

confidence: 99%

Clinical outcome of neonatal bacterial meningitis according to birth weight

Krebs¹,

Costa²

2007

Arq. Neuro-Psiquiatr.

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“…2,11,16 The mortality rate for GNR meningitis in our sample, 13%, is lower than most previously published findings. One reason for this finding may be our inclusion of all neonates with meningitis regardless of birth weight.…”

Section: Discussioncontrasting

confidence: 69%

“…Prompt identification of GNR meningitis in order to institute proper antimicrobial treatment is crucial in improving outcomes. 16 CSF parameters are often used to determine if empirical therapy should be given or if patients should be treated for meningitis in the presence of negative CSF cultures. 10 Previous studies examining GPC and GNR CSF parameters are limited.…”

Section: Discussionmentioning

confidence: 99%

A comparison of neonatal Gram-negative rod and Gram-positive cocci meningitis

et al. 2006

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Objective: Neonatal meningitis is an illness with potentially devastating consequences. Early identification of potential risk factors for Gram-negative rod (GNR) infections versus Gram-positive cocci (GPC) infection prior to obtaining final culture results is of value in order to appropriately guide expirical therapy. We sought to compare laboratory and clinical parameters of GNR and GPC meningitis in a cohort of term and premature infants.Study Design: We evaluated lumbar punctures from neonates cared for at 150 neonatal intensive care units managed by the Pediatrix Medical Group Inc. We compared cerebrospinal fluid (CSF) parameters (white blood cell count, red blood cell count, glucose, and protein), demographics, and outcomes between infants with GNR and GPC meningitis. CSF cultures positive with coagulase-negative staphylococci were excluded. Results:We identified 77 infants with GNR and 86 with GPC meningitis. There were no differences in gestational age, birth weight, infant sex, race, or rate of Caesarean section. GNR meningitis was more often diagnosed after the third postnatal day and was associated with higher white blood cell and red blood cell counts. GNR meningitis diagnosed in the first 3 days of life was associated with antepartum antibiotic exposure. No difference was noted in either CSF protein or glucose levels. After correcting for gestational age, there was no observed difference in mortality between infants infected with GNR or GPC.Conclusion: Compared to GPC meningitis, GNR meningitis was associated with several aspects of the clinical history and laboratory findings including older age of presentation, antepartum exposure to antibiotics, and elevated CSF white blood cell and red blood cell counts.

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“…Mortality rates are reported to be about 84% and because the organism is especially virulent, prompt CSF sterilization is believed to be imperative for favorable outcome. 3,5,6,18 Although clinical experience is still limited, the use of ceftazidime and an aminoglycoside is recommended as the therapy of choice for P. aeruginosa meningitis. 6,[14][15][16] Intraventricular aminoglycoside dosing regimens vary among reports and range from doses of 1 to 5 mg/day for tobramycin and gentamicin and 7.5 to 22 mg/day for amikacin and have included concurrent systemic therapy.…”

Section: Discussionmentioning

confidence: 99%

Intraventricular and Intravenous Tobramycin with Ceftazidime for Ventriculitis Secondary to Pseudomonas aeruginosa

Masvosva

Buckingham

Einhaus³

et al. 2003

The Journal of Pediatric Pharmacology and Therapeutics

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The preferred method for shunting cerebrospinal fluid in the ventricles is via a ventriculoperitoneal or ventriculoatrial shunt. Unfortunately, infection is a major complication of shunt surgery, which places the patient at risk of intellectual impairment and death. Although the most common causative pathogens are Staphylococcus epidermidis and Staphylococcus aureus, gram-negative bacterial infections have increased over the last three decades. Treatment of Pseudomonas ventriculitis is highly variable, because there are few guidelines for drug selection, administration, and monitoring. We report a case of post-shunt revision Pseudomonas meningitis/ ventriculitis that was successfully treated by the intraventricular adminstration tobramycin in conjunction with intravenous tobramycin and ceftazidime.

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Meningeal inflammation in neonatal Gram-negative bacteremia

Cited by 12 publications

References 0 publications

Clinical outcome of neonatal bacterial meningitis according to birth weight

Clinical outcome of neonatal bacterial meningitis according to birth weight

A comparison of neonatal Gram-negative rod and Gram-positive cocci meningitis

Intraventricular and Intravenous Tobramycin with Ceftazidime for Ventriculitis Secondary to Pseudomonas aeruginosa

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