Incidence of meningitis in term neonates with sepsis and antibiotic sensitivity pattern: an observational study

Authors

  • Lakshmi Aparna Devi V. V. Department of Pediatrics, SVS Medical College, Mahbubnagar, Telangana, India
  • Chapay Soren Department of Pediatrics, SVS Medical College, Mahbubnagar, Telangana, India
  • M. Umadevi Department of Pediatrics, SVS Medical College, Mahbubnagar, Telangana, India
  • R. Pradeep Department of Pediatrics, SVS Medical College, Mahbubnagar, Telangana, India

DOI:

https://doi.org/10.18203/2349-3291.ijcp20195734

Keywords:

Antibiotic sensitivity, Bacteriological profile, Meningitis, Neonatal septicemia

Abstract

Background: To find out the incidence of meningitis in neonatal sepsis and antibiotic sensitivity pattern in term neonates.

Methods: This prospective observational cohort study was done in a tertiary care hospital located in rural South India for a period of 2 years. Blood culture and lumbar puncture were performed for all term babies with clinically suspected sepsis. Growth, if detected was followed by antibiotic sensitivity testing.

Results: Of a total of 50 neonates investigated with blood culture, 32(64%) were found to be culture positive for neonatal septicemia, 16 were diagnosed to have meningitis. Meningitis was present in 4(25%) early onset sepsis cases and in 12(75%) late onset sepsis cases (p-value: 0.008). Blood culture showed growth in all of the 16 cases of meningitis, but Cerebro Spinal Fluid (CSF) culture was positive in 5 cases. The most common presenting features are lethargy, seizures, decreased acceptance of feeds, instability of temperature regulation, vomiting, respiratory distress, and apnea. The most common organism in blood culture was Coagulase Negative Staphylococcus (CONS) (20%) followed by Klebsiella spp. (16%). CONS was most sensitive to Linezolid (100%), Vancomycin (90%). Of the 8 cases of Klebsiella, 62.5% cases were sensitive to Colistin and Tigecycline, 50% to Cotrimoxazole. CSF culture was positive in 5(31.25%) cases. CONS and Enterococci spp. were the most common organisms isolated in CSF.

Conclusions: Clinical manifestations of meningitis overlap with those of sepsis and are nonspecific. Significant number of neonates with sepsis have meningitis. Hence, it is necessary to rule out meningitis in neonates presented with clinical features of sepsis. CONS was the most common agent isolated in both blood and CSF culture. Routine bacterial surveillance and study of their resistance patterns must be an essential component of neonatal care which helps in implementation of a rational empirical treatment strategy.

References

Schaffner J, Chochua S, Kourbatova EV, Barragan M, Wang YF, Blumberg HM, et al. High mortality among patients with positive blood cultures at a children's hospital in Tbilisi, Georgia. J Inf Develop Count. 2009;3(4):267.

Lawn JE, Cousens S, Zupan J, Lancet Neonatal Survival Steering Team. 4 million neonatal deaths: when? Where? Why?. Lancet. 2005;365(9462):891-900.

Agrawal R, Sarkar N, Deorary AK, Paul VK. Sepsis in newborn. Ind J Pediatr. 2001;68:1143-7.

Sekar S, Agatha D, Selvi R. Study of Microorganisms Causing Neonatal Sepsis in a Tertiary Care Hospital and their Antimicrobial Susceptibility Pattern. Int J Curr Microbiol App Sci. 2017;6(10):669-77.

de Vries LS, Volpe JJ. Bacterial and fungal intracranial infections. In Volpe's Neurology of the Newborn Elsevier; 2018;1050-89.

Remington JS, Klein JO. Infectious diseases of the fetus and newborn infant. WB Saunders; 2001.

Paolucci M, Landini MP, Sambri V. How can the microbiologist help in diagnosing neonatal sepsis?. Int J Pediatr. 2012;2012.

Hornik CP, Fort P, Clark RH, Watt K, Benjamin Jr DK, et al. Early and late onset sepsis in very-low-birth-weight infants from a large group of neonatal intensive care units. Early Human Develop. 2012;88:S69-74.

Edmond K, Zaidi A. New approaches to preventing, diagnosing, and treating neonatal sepsis. PLoS Med. 2010;7(3):1000213.

Jiang JH, Chiu NC, Huang FY, Kao HA, Hsu CH, Hung HY, et al. Neonatal sepsis in the neonatal intensive care unit: characteristics of early versus late onset. J Microbiol Immunol Infect. 2004;37(5):301-6.

Sanghvi KP, Tudehope DI. Neonatal bacterial sepsis in a neonatal intensive care unit: a 5 year analysis. J Paediatr Child Health. 1996;32(4):333-8.

Stoll BJ, Hansen N, Fanaroff AA, Wright LL, Carlo WA, Ehrenkranz RA, et al. Changes in pathogens causing early-onset sepsis in very-low-birth-weight infants. New Engl J Med. 2002;347(4):240-7.

Iregbu KC, Elegba OY, Babaniyi IB. Bacteriological profile of neonatal septicaemia in a tertiary hospital in Nigeria. African Health Sci. 2006;6(3):151-4.

Kuruvilla KA, Pillai S, Jesudason M, Jana AK. Bacterial profile of sepsis in a neonatal unit in south India. Ind Pediatr. 1998;35(9):851-8.

Chacko B, Sohi I. Early onset neonatal sepsis. Ind J Pediatr. 2005;72:23-6.

Meherban Singh. Perinatal Infections. In: Care of the Newborn. 8th ed. New Delhi. Sagar Publications 2015;208-40.

Byington CL, Kendrick J, Sheng X. Normative cerebrospinal fluid profiles in febrile infants. J Pediatr. 2011;158(1):130-4.

Kestenbaum LA, Ebberson J, Zorc JJ, Hodinka RL, Shah SS. Defining cerebrospinal fluid white blood cell count reference values in neonates and young infants. Pediatr. 2010;125(2):257-64.

Ahmed A, Hickey SM, Ehrett S, Trujillo M, Brito F, Goto C, et al. Cerebrospinal fluid values in the term neonate. Pediatr Infect Dis J. 1996;15(4):298-303.

Hristeva L, Booy R, Bowler I, Wilkinson AR. Prospective surveillance of neonatal meningitis. Archiv Dis Childhood. 1993;69:14-8.

Aletayeb MH, Ahmad FS, Masood D. Eleven‐year study of causes of neonatal bacterial meningitis in Ahvaz, Iran. Pediatr Int. 2010;52(3):463-6.

Kavuncuoğlu S, Gürsoy S, Türel Ö, Aldemir EY, Hoşaf E. Neonatal bacterial meningitis in Turkey: epidemiology, risk factors, and prognosis. J Inf Develop Count. 2013;7(02):073-81.

Khalessi N, Afsharkhas L. Neonatal meningitis: risk factors, causes, and neurologic complications. Iranian J Child Neurol. 2014;8(4):46.

Ferrieri P. Neonatal Bacterial Sepsis-Neonatal Bacterial Meningitis. In: Christine A. Gleason, Sherin U. Devaskar., eds. Avery’s diseases of the newborn. 10th ed. Philadelphia: Saunders; 2012:538-50.

Klinger G, Chin CN, Beyene J, Perlman M. Predicting the outcome of neonatal bacterial meningitis. Pediatr. 2000;106(3):477-82.

Malbon K, Mohan R, Nicholl R. Should a neonate with possible late onset infection always have a lumbar puncture?. Archiv Dis Childhood. 2006;91(1):75-6.

Al-Harthi A, Dagriri K, Asindi AA, Bello CS Neonatal meningitis. Saudi Med J. 2000;21:550-3.

Kamoun F, Dowlut MB, Ameur SB, Sfaihi L, Mezghani S, Chabchoub I, et al. Neonatal purulent meningitis in southern Tunisia: Epidemiology, bacteriology, risk factors and prognosis. Fetal Pediatr Pathol. 2015;34(4):233-40.

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Published

2019-12-24

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Original Research Articles