Delayed cerebrospinal fluid sterilization and adverse outcome of bacterial meningitis in infants and children
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1Department of Pediatrics, University of Texas, Dallas.
Abstract:
To determine the clinical importance of CSF cultures that are persistently positive for pathogens in patients treated for meningitis with the new cephalosporins, the records of 301 infants and children with bacterial meningitis enrolled prospectively in four clinical efficacy trials of cefuroxime or ceftriaxone therapy were reviewed. CSF culture results were positive for 20 patients and they were sterile at 18 to 36 hours after start of therapy for 281 patients. Seizures, subdural effusions, and hemiparesis were found significantly more often during hospitalization in those with delayed sterilization of CSF. Children with persistently positive cultures had a significantly higher incidence of neurologic abnormalities at the time of hospital discharge (45% v 19%) and at follow-up (41% v 13%) and of moderate to profound hearing impairment (35% v 15%) than did those with prompt sterilization of CSF. Repeat CSF examination is a useful prognostic indicator in infants and young children with bacterial meningitis.
Insights
Persistent cerebrospinal fluid (CSF) infections in children treated for bacterial meningitis indicate a higher risk of serious complications and long-term neurological issues. Early sterilization of CSF cultures is crucial for a better prognosis.
Area of Science:
- Pediatric Infectious Diseases
- Clinical Microbiology
- Neurology
Background:
- Bacterial meningitis remains a significant cause of morbidity and mortality in infants and children.
- Newer cephalosporin antibiotics like cefuroxime and ceftriaxone are commonly used for treatment.
- The clinical significance of persistently positive cerebrospinal fluid (CSF) cultures during antibiotic therapy is not fully understood.
Purpose of the Study:
- To evaluate the clinical importance of persistently positive CSF cultures in children treated for bacterial meningitis.
- To assess the association between delayed CSF sterilization and patient outcomes.
Main Methods:
- Prospective review of records from 301 infants and children with bacterial meningitis.
- Participants were enrolled in four clinical efficacy trials of cefuroxime or ceftriaxone.
- CSF culture results were analyzed for timing of sterilization (positive vs. sterile).
Main Results:
- 20 patients had persistently positive CSF cultures, while 281 had sterile cultures within 18-36 hours.
- Delayed CSF sterilization was significantly associated with increased incidence of seizures, subdural effusions, and hemiparesis.
- Children with persistently positive cultures showed higher rates of neurological abnormalities and hearing impairment at discharge and follow-up.
Conclusions:
- Persistently positive CSF cultures in pediatric bacterial meningitis are linked to adverse clinical outcomes.
- Delayed sterilization of CSF cultures is a significant indicator of potential complications.
- Repeat CSF examination serves as a valuable prognostic tool in managing pediatric bacterial meningitis.