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.
Highlights
Meningitis is associated with high mortality and longterm complications among survivors in the neonatal period [1,2,3]
If multiple blood cultures could be paired with the same cerebrospinal fluid (CSF) culture, they were each counted as separate blood-CSF culture pair
If multiple CSF cultures could be paired with the same blood culture, we kept, in order of preference, a positive CSF culture over a negative CSF culture, a CSF culture obtained on the same day over a CSF culture obtained before or after the blood culture, and a CSF culture obtained closest in time before or after the blood culture
Summary
Meningitis is associated with high mortality and longterm complications among survivors in the neonatal period [1,2,3]. When evaluating an infant for sepsis, many clinicians choose to obtain a blood culture and await a positive result before performing a lumbar puncture. This strategy underestimates the incidence of meningitis; up to 50% of very low birth weight [8]. The concordance between blood, urine and CSF cultures may affect management strategies for sepsis. The majority (61.4%) of late-onset sepsis cases are caused by Gram-positive organisms [9]. Prior studies have found 39% of blood and CSF cultures to be concordant with Gram-positive organisms compared with 16% of blood and urine cultures [10,11]. The relationship between individual organisms present in blood and CSF cultures, as well as between concordance and the timing of blood and CSF cultures, have not been fully described
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