Antimicrobial Resistance and Predictors of Adverse Outcomes in Neonates with Bacterial Meningitis: A Retrospective Study from a Tertiary Care Hospital of Northern India

Abstract

This study aimed to determine antimicrobial resistance pattern and predictors of adverse outcome in neonatal meningitis. A retrospective study by analyzing case files of 134 cases of neonatal meningitis. We noted an alarming degree of multidrug resistance (MDR) among both gram-negative (Klebsiella spp., 50%; Escherichia coli, 100%; and and Acinetobacter spp., 50%), as well as positive (Enterococcus, 100%) isolates in cerebrospinal fluid (CSF) culture. The incidence rate of adverse outcome (i.e., mortality and abnormal neurological examination at discharge) was 8.2 and 17.2%, respectively. On univariate analysis, delayed seeking of medical care, bulging anterior fontanelle, vomiting, positive sepsis screen, shock during hospital course, ventriculitis, diversion procedures for raised intracranial pressure, central line placement, low CSF sugar, and failed hearing screening test at discharge were associated with increased risk of adverse outcome. Further, delayed seeking of medical care, shock during hospital course, positive sepsis screen, thrombocytopenia, and MDR infections were independently found to be associated with adverse outcomes. An alarming degree of antimicrobial resistance among the CSF isolates necessitates the need to understand the pathogenesis of resistance and curtail the irrational prescription of antibiotics in neonatal meningitis. Further, delayed seeking of medical care, shock during hospital course, positive sepsis screen, thrombocytopenia, and MRD infection may have prognostic value in neonatal meningitis

Diagnostic Utility of Cerebrospinal Fluid Procalcitonin in Neonatal Meningitis

“…4 Hence, neonatal meningitis is often over diagnosed in clinical setting which usually leads to unnecessary exposure of neonates to prolonged duration of antibiotics which in turn increases the risk of adverse effects due to exposure to drugs as well as it also increases the risk of antimicrobial resistance. 5,6 Hence, there is an urgent need for a new in ammatory marker which can accurately diagnose neonatal meningitis in babies with neonatal sepsis and hence, in turn will reduce the rates of above said complications associated with the disease as well as its treatment. One of such marker is procalcitonin which is a precursor of calcitonin and is a reliable marker of infection and the associated in ammation.…”