Acute Bacterial Meningitis Beyond the Neonatal Period

Panuganti, Suresh Kumar; Nadel, Simon

doi:10.1016/b978-0-323-40181-4.00040-2

Cited by 4 publications

(8 citation statements)

References 103 publications

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“…They are cheap and well-validated tools but the sensitivity varies by different age groups, types of meningeal pathogens and by the use of previous antibiotic therapy. [26][27][28][29][30][31] The sensitivity of the Gram stain in neonates is ~60% 31 while in children it ranges from 50% to 63%. 32,33 The sensitivity also ranges by pathogen: 90% in S. pneumoniae meningitis, 34,35 80% in N. meningitides, 50% in Gram-negative bacillary meningitis, and 30% in L. monocytogenes.…”

Section: Diagnosismentioning

confidence: 99%

“… 21 , 67 , 68 As a result to that, vancomycin plus either cefotaxime or ceftriaxone should be used as empirical antibiotics in children presenting with signs and symptoms of ABM in the United States or Europe where the incidence of ceftriaxone-resistant pneumococcus is >1%. 18 , 21 , 30 , 65 When the causative organism and its antibiotic susceptibilities are determined, specific targeted therapy can be provided.…”

Section: Managementmentioning

confidence: 99%

“… 18 , 21 , 30 , 65 When the causative organism and its antibiotic susceptibilities are determined, specific targeted therapy can be provided.…”

Section: Managementmentioning

confidence: 99%

“… 21 , 28 Characteristic CSF findings for bacterial meningitis consist of polymorphonuclear pleocytosis (WBC >1000 Cells/µL, 80–90% polymorphonuclear cells), hypoglycorrachia (CSF glucose <40 mg/dL, a ratio of CSF to serum glucose of ≤0.4 in children and ≤0.6 in term neonates) and elevated CSF protein levels >150 mg/dL. 21 , 29 , 30 In the pediatric population, CSF indexes vary with age, with poorly defined normal values especially in infants. 11 Gram stain and culture remains the most important tool for diagnosis of ABM.…”

Section: Introductionmentioning

confidence: 99%

“…The Most Common Organism Causing Acute Bacterial Meningitis per Age Group with the Recommended Standard Therapy Based on in vitro Susceptibility Testing18,21,30,69,70,[91][92][93][94][95] …”

mentioning

confidence: 99%

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<p>Management of Acute Bacterial Meningitis in Children</p>

Alamarat¹,

Hasbun²

2020

IDR

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Acute community-acquired bacterial meningitis (ABM) in children continues to have high rates of neurological morbidity and mortality despite the overall declining rates of infection attributed to the use of vaccines and intrapartum Group B Streptococcus prophylaxis. Prompt diagnosis and early antibiotic therapy are crucial and should not be delayed to obtain cranial imaging. Differentiating bacterial from viral meningitis continues to be a clinical dilemma especially in patients with previous antibiotic exposure. Clinical models and inflammatory biomarkers can aid clinicians in their diagnostic approach. Multiplex polymerase chain reaction and metagenomic next-generation sequencing are promising tools that can help in early and accurate diagnosis. This review will present the epidemiology of ABM in children, indications of cranial imaging, role of different models and serum biomarkers in diagnosing ABM, and management including the use of adjunctive therapies and methods of prevention.

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Section: Diagnosismentioning

confidence: 99%

Section: Managementmentioning

confidence: 99%

“… 18 , 21 , 30 , 65 When the causative organism and its antibiotic susceptibilities are determined, specific targeted therapy can be provided.…”

Section: Managementmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

mentioning

confidence: 99%

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<p>Management of Acute Bacterial Meningitis in Children</p>

Alamarat¹,

Hasbun²

2020

IDR

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Impact of decreasing cerebrospinal fluid enterovirus PCR turnaround time on costs and management of children with suspected enterovirus meningitis

Alghounaim

Caya

Cho

et al. 2020

Eur J Clin Microbiol Infect Dis

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To estimate the impact of implementing in-hospital enterovirus (EV) polymerase chain reaction (PCR) testing of cerebrospinal fluid (CSF) with same-day turn-around-time (TAT) on length-of-stay (LOS), antibiotic use and on cost per patient with suspected EV meningitis, compared with testing at an outside reference laboratory. A model-based analysis using a retrospective cohort of all hospitalized children with CSF EV PCR testing done between November 2013 and 2017. The primary outcome measured was the potential date of discharge if the EV PCR result had been available on the same day. Patients with positive EV PCR were considered for potential earlier discharge once clinically stable with no reason for hospitalization other than intravenous antibiotics. Descriptive statistics and cost-sensitivity analyses were performed. CSF EV PCR testing was done on 153 patients, of which 44 (29%) had a positive result. Median test TAT was 5.3 days (IQR 3.9-7.6). Median hospital LOS was 5 days (IQR 3-12). Most (86%) patients received intravenous antibiotics with mean duration of 5.72 ± 6.51 days. No patients with positive EV PCR had a serious bacterial infection. We found that same-day test TAT would reduce LOS and duration of intravenous antibiotics by 0.50 days (95%CI 0.33-0.68) and 0.67 days (95%CI 0.42-0.91), respectively. Same-day test TAT was associated with a cost reduction of 342.83CAD (95%CI 178.14-517.00) per patient with suspected EV meningitis. Compared with sending specimens to a reference laboratory, performing CSF EV PCR in-hospital with same-day TAT was associated with decreased LOS, antibiotic therapy, and cost per patient.

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The Evaluation of the Diagnostic Performance of the BioFire FilmArray Meningitis/Encephalitis Panel in Children: A Retrospective Multicenter Study

Bal

Saz

Arslan

et al. 2022

J Pediatr Infect Dis

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Objective Acute bacterial meningitis (ABM) declined after implementing conjugate Haemophilus influenzae type B and the pneumococcal vaccines worldwide. However, it still contributes to significant morbidity and mortality. The Biofire FilmArray Meningitis Encephalitis (FAME) panel can rapidly diagnose common bacterial and viral pathogens. Several studies suggested that the use of FAME may accelerate diagnosis and decrease the time to pathogen-specific therapy. However, the clinical utility is still controversial due to scarce data and relatively high costs. Therefore, we aimed to evaluate the diagnostic performance of FAME in children. Methods A retrospective multicenter cross-sectional study was conducted to evaluate FAME in diagnosing ABM in children with a suspected central nervous system infection between January 2017 and May 2021. Results This study consisted of 179 children diagnosed with central nervous system infection who had parallel testing done using FAME and traditional microbiological diagnostic methods. Twenty-two FAME results were positive; 8 (36.3%) were bacterial pathogens and 14 (53.7%) were viral pathogens. The most common viral pathogen was human herpesvirus 6 (n = 6; 27.2%), followed by herpes simplex virus 1 (n = 4; 18.1%), Enterovirus spp. (n = 2; 9%), Parechovirus (n = 2; 9%), and Cytomegalovirus (n = 1; 4.5%). Bacterial pathogens included S. pneumoniae (n = 3; 13.6%), H. influenzae (n = 3; 13.6%), Neisseria meningitidis (n = 1; 4.5%), and Streptococcus agalactiae (n = 1; 4.5%). Bacterial culture confirmed S. pneumoniae infection in only 1 of 8 (12.5%) patients, while 7 of 8 bacterial meningitis were only detected by FAME. Conclusion FAME may also help with diagnosis and pathogen identification in patients who have already had antibiotics before cerebrospinal fluid collection. The use of FAME to detect infections quickly may minimize the improper use of medications, treatment duration, and the cost of hospitalization.

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Acute Bacterial Meningitis Beyond the Neonatal Period

Cited by 4 publications

References 103 publications

<p>Management of Acute Bacterial Meningitis in Children</p>

<p>Management of Acute Bacterial Meningitis in Children</p>

Impact of decreasing cerebrospinal fluid enterovirus PCR turnaround time on costs and management of children with suspected enterovirus meningitis

The Evaluation of the Diagnostic Performance of the BioFire FilmArray Meningitis/Encephalitis Panel in Children: A Retrospective Multicenter Study

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