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Delayed cerebrospinal fluid sterilization in infants with Hemophilus influenzae type b meningitis
1Communicable Disease Service, Los Angeles County Hospital-University of Southern California Medical Center.
Insights
Delayed cerebrospinal fluid (CSF) sterilization occurred in infants with bacterial meningitis, particularly those infected with Haemophilus influenzae type b. Younger infants were at higher risk, even with appropriate antibiotic treatment.
Area of Science:
- Pediatrics
- Infectious Diseases
- Microbiology
Background:
- Bacterial meningitis remains a significant cause of morbidity and mortality in infants and children.
- Cerebrospinal fluid (CSF) sterilization is a key indicator of effective antibiotic treatment for bacterial meningitis.
- Delayed CSF sterilization can lead to prolonged illness and potential long-term complications.
Purpose of the Study:
- To identify risk factors associated with delayed CSF sterilization in children treated for bacterial meningitis.
- To investigate the role of specific bacterial pathogens and patient demographics in treatment outcomes.
Main Methods:
- A case-control study was conducted involving children aged 6 weeks to 6 years treated for bacterial meningitis between 1975 and 1985.
- Cases were defined as patients with delayed CSF sterilization (>24 hours after initiating intravenous antibiotics).
- Statistical analysis, including odds ratios and confidence intervals, was used to determine risk factors.
Main Results:
- Haemophilus influenzae type b (Hib) was isolated in all patients with delayed CSF sterilization (n=5) compared to 78% of the overall study population (n=83).
- Infants under 6 months with Hib meningitis had a significantly higher risk of delayed CSF sterilization (OR=7.5, 95% CI: 1.4-40.0).
- Factors such as timing of lumbar puncture, CSF cell counts, protein, and glucose levels were not associated with delayed sterilization.
Conclusions:
- Delayed CSF sterilization can occur in infants with bacterial meningitis, even when treated with antibiotics like ceftizoxime and ceftazidime to which Haemophilus influenzae type b is susceptible in vitro.
- Younger infants (<6 months) with Hib meningitis are particularly vulnerable to delayed treatment response.
- Further research may be warranted to understand the mechanisms behind delayed sterilization in specific pediatric populations.
Abstract:
Cerebrospinal fluid (CSF) sterilization after greater than 24 h of intravenous antibiotic therapy (delayed CSF sterilization) was noted in two infants treated with ceftizoxime and ceftazidime for bacterial meningitis. A case-control study was conducted of children between 6 w and 6 y of age treated between 1975 and 1985 at one institution for bacterial meningitis to determine risk factors for delayed CSF sterilization. Hemophilus influenzae type b was isolated from all children (n = 5) with delayed CSF sterilization, compared with only 78% of all children in the study (n = 83). In children with H. influenzae type b disease, children less than 6 mo of age were at higher risk than older children for delayed CSF sterilization (odds ratio = 7.5, 95% confidence limits = 1.4, 40.0). Factors not associated with delayed CSF sterilization included time of follow-up lumbar puncture, CSF total or differential white blood cell count, and CSF protein and glucose concentrations. Despite the in vitro antimicrobial susceptibility of H. influenzae type b to ceftizoxime and ceftazidime, delayed CSF sterilization may occur in infants receiving these antibiotics for bacterial meningitis.