The Epidemiology, Management, and Outcomes of Bacterial Meningitis in Infants

被引:186
作者
Ouchenir, Lynda [1 ]
Renaud, Christian [1 ]
Khan, Sarah [2 ]
Bitnun, Ari [2 ]
Boisvert, Andree-Anne [3 ]
McDonald, Jane [3 ]
Bowes, Jennifer [4 ]
Brophy, Jason [4 ]
Barton, Michelle [5 ]
Ting, Joseph [6 ]
Roberts, Ashley [6 ]
Hawkes, Michael [7 ]
Robinson, Joan L. [7 ]
机构
[1] Univ Montreal, Ctr Hosp Univ St Justine, Montreal, PQ, Canada
[2] Univ Toronto, Hosp Sick Children, Dept Pediat, Toronto, ON, Canada
[3] McGill Univ, Montreal Childrens Hosp, Montreal, PQ, Canada
[4] Univ Ottawa, Childrens Hosp Eastern Ontario, Ottawa, ON, Canada
[5] Western Univ, London Hlth Sci Ctr, London, ON, Canada
[6] Univ British Columbia, British Columbia Childrens Hosp, Vancouver, BC, Canada
[7] Univ Alberta, Stollery Childrens Hosp, Dept Pediat, Edmonton, AB, Canada
关键词
GROUP-B STREPTOCOCCUS;
D O I
10.1542/peds.2017-0476
中图分类号
R72 [儿科学];
学科分类号
100202 [儿科学];
摘要
OBJECTIVES: The pathogens that cause bacterial meningitis in infants and their antimicrobial susceptibilities may have changed in this era of increasing antimicrobial resistance, use of conjugated vaccines, and maternal antibiotic prophylaxis for group B Streptococcus (GBS). The objective was to determine the optimal empirical antibiotics for bacterial meningitis in early infancy. METHODS: This was a cohort study of infants <90 days of age with bacterial meningitis at 7 pediatric tertiary care hospitals across Canada in 2013 and 2014. RESULTS: There were 113 patients diagnosed with proven meningitis (n = 63) or suspected meningitis (n = 50) presented at median 19 days of age, with 63 patients (56%) presenting a diagnosis from home. Predominant pathogens were Escherichia coli (n = 37; 33%) and GBS (n = 35; 31%). Two of 15 patients presenting meningitis on day 0 to 6 had isolates resistant to both ampicillin and gentamicin (E coil and Haemophilus influenzae type B). Six of 60 infants presenting a diagnosis of meningitis from home from day 7 to 90 had isolates, for which cefotaxime would be a poor choice (Listeria monocytogenes [n = 3], Enterobacter cloacae, Cronobacter sakazakii, and Pseudomonas stutzeri). Sequelae were documented in 84 infants (74%), including 8 deaths (7%). CONCLUSIONS: E coli and GBS remain the most common causes of bacterial meningitis in the first 90 days of life. For empirical therapy of suspected bacterial meningitis, one should consider a third-generation cephalosporin (plus ampicillin for at least the first month), potentially substituting a carbapenem for the cephalosporin if there is evidence for Gram-negative meningitis.
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