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Bacterial meningitis. A follow-up study of 115 children
Insights
This study on pediatric bacterial meningitis found Gram-negative bacteria in neonates and resistant *Hemophilus influenzae* in older children. Ampicillin and aminoglycosides are effective, with chloramphenicol recommended for neonates.
Area of Science:
- Pediatric Infectious Diseases
- Clinical Microbiology
- Neuroscience
Background:
- Bacterial meningitis remains a significant cause of mortality and morbidity in pediatric populations.
- Accurate bacteriologic diagnosis can be challenging due to prior antimicrobial treatment.
- Neonatal meningitis often involves Gram-negative enteric bacteria, while *Hemophilus influenzae* type B is common in older infants.
Purpose of the Study:
- To present clinical and laboratory data on 115 pediatric patients with bacterial meningitis.
- To identify common etiologic agents and their antimicrobial resistance patterns.
- To evaluate treatment efficacy and outcomes, including mortality and neurologic sequelae.
Main Methods:
- Retrospective analysis of clinical and laboratory data from 115 pediatric patients.
- Bacteriologic culture and sensitivity testing for isolated pathogens.
- Review of treatment regimens, patient outcomes, and neurological complications.
Main Results:
- *Escherichia coli* was prevalent in 9 of 13 neonates; *Hemophilus influenzae* type B accounted for 56% of isolates in older children (>2 months).
- 35% of *Hemophilus influenzae* isolates showed resistance to chloramphenicol.
- 73% of patients recovered fully after 10-14 days of antimicrobial therapy; 15 patients died, primarily neonates.
Conclusions:
- Ampicillin and aminoglycosides demonstrate efficacy in treating bacterial meningitis.
- Chloramphenicol may be preferred in the postnatal period due to partial ampicillin resistance in *Hemophilus influenzae*.
- Streptococcus group B and *H. influenzae* are infrequent causes of neonatal meningitis.
Abstract:
The clinical and laboratory date on 115 pediatric patients with bacterial meningitis are presented. Sixty-one were less than 12 mo of age including 13 less than 1 mo of age. Thirty-nine children were treated prior to admission with antimicrobial agents which obscured accurate bacteriologic diagnosis in eight of them. Gram-negative enteric bacteria, mainly Escherichia coli, were recorded in 9 of 13 neonates. Hemophilus influenzae type B accounted for 56 (52%) of all isolated recorded in those greater than 2 mo of age, of which 35% were resistant to chloramphenicol. Seventy-eight patients (73%) recovered completely following 10 to 14 days of antimicrobial therapy. Fifteen patients died, most of whom were less than 1 yr of age, including five neonates. Major neurologic sequelae included subdural effusions, cerebral abscesses and recurrent convulsions. This study, which documents the infrequency of Streptococcus group B and H. influenzae as etiological agents of neonatal meningitis, indicates that treatment of this disease with ampicillin and an aminoglycoside is efficacious. Chloramphenicol may be the drug of choice in the postnatal period, since H. influenzae is partly resistant to ampicillin.