Etiology, clinical findings and laboratory parameters in neonates with acute bacterial meningitis

Abstract

Background and Objectives: Neonatal meningitis is one of the most important and serious neonatal infections with a high mortality and morbidity rate. The present study aimed to investigate the causes, clinical signs, laboratory parameters and mortality rates in newborns with bacterial meningitis.
 Materials and Methods: This cross-sectional study was performed on 468 neonates aged 2-28 days admitted to NICU in Ghaem Hospital Mashhad, Iran by available sampling method during 2009-2018. Meningitis was confirmed according to positive results of CSF culture and clinical feature. By using researcher-made questionnaire, neonate's individual data in- cluding cardiopulmonary resuscitation, the Apgar score of the first and fifth minutes, gestational age, birth weight, clinical symptoms and laboratory data such as ESR, WBC and positive culture of CSF were studied.
 Results: Among 468 newborn suspected to infection, lumbar Puncture (LP) was performed for 233 cases (50%). Of 233 neonates, 148 neonates (63.5%) had negative results for CSF culture and 85 cases (36.5%) had positive CSF culture. 94% of cases with meningitis were born premature. Blood culture had positive results in 80% of infants with late-onset meningitis and negative in 20%. The most common clinical findings were respiratory symptoms (94%). Klebsiella pneumoniae and Entrobacter aerugenes were the most common microorganisms of meningitis. Gestational disorders were observed in 55.3% of newborns with meningitis. C-Reactive Protein (CRP) of neonates with meningitis was twice higher than normal cases, and leukocytes and proteins in the CSF in neonates with meningitis were higher than healthy ones. Finally, 36% of neonates with meningitis died in our study. For analyzing the relationships between variables, independent t-test was used after controlling the normality, and Chi-square was used for analyzing the relationship of variables with nominal scale.
 Conclusion: The most common pathogens of meningitis were Klebsiella pneumoniae and Enterobacter aerogenes. Respi- ratory symptoms were the most common clinical signs, and laboratory symptoms included increased CRP, increased leuko- cytes and proteins in CSF

Etiology of Neonatal Bacterial Meningitis and Their Antibiotic Susceptibility Pattern at the University of Gondar Comprehensive Specialized Hospital, Ethiopia: A Seven-Year Retrospective Study

“…The results of our study showed that both Gram-negative (73.7%) and Gram-positive (26.3%) bacterial isolates were responsible for NBM, with K. pneumoniae (36.8%), NLF-GNR (21%), and GBS (15.8%) were the leading bacterial isolates. Similar to our finding, hospital-based studies from Mexico 35 and Iran 36 , 37 reported K. pneumoniae as the leading cause of NBM. Bacteria in the Enterobacteriaceae group, including K. pneumoniae , are known to cause nosocomial infections in neonates.…”

Meningitis due to Enterobacter aerogenes in the community associated with congenital dermal sinus in a Japanese infant

“…A literature review of reports concerning patients with congenital dermal sinus disease who developed abscesses showed similar causative bacteria; however, there were no cases linked to Enterobacter aerogenes [8] . Meningitis due to Enterobacter aerogenes has been reported only in specific conditions, such as patients undergoing neurosurgical procedures [9] , [10] , [11] and neonates in the NICU [3] . In the present case, we considered that the hematogenous infection was negative, since the blood culture was negative.…”

“…cause opportunistic and nosocomial infections in the intensive care unit (ICU) [2] . Moreover, pediatric meningitis due to Enterobacter aerogenes has been reported in neonates in the neonatal ICU (NICU) [3] . However, community-acquired infections due to Enterobacter aerogenes associated with congenital dermal sinus in non-neonates have rarely been reported.…”

A Yersiniabactin-producing Klebsiella aerogenes Strain Causing an Outbreak in an Austrian Neonatal Intensive Care Unit

“…3,4 K. aerogenes is known to cause nosocomial pneumonia, urinary tract and bloodstream infection in adults, especially immunocompromised and intensive care patients [4][5][6] but can also lead to necrotizing enterocolitis, meningitis or sepsis in preterm infants. [7][8][9][10] Unlike other Enterobacteriaceae, K. aerogenes rarely causes outbreaks in neonatal intensive care units (NICU). Some NICU outbreaks with K. aerogenes have been reported previously, causing substantial morbidity and mortality.…”

“…3,4 K. aerogenes is known to cause nosocomial pneumonia, urinary tract and bloodstream infection in adults, especially immunocompromised and intensive care patients 4–6 but can also lead to necrotizing enterocolitis, meningitis or sepsis in preterm infants. 7–10…”