Bacterial Meningitis in Neonates: A Multicenter Descriptive Study in the City of Medellín, Colombia
DOI:
https://doi.org/10.17533/udea.iatreia.192Palabras clave:
Antiinfecciosos, Meningitis Bacteriana, Pleocitosis, Recién Nacido, Registros Médicos, Sepsis, Anti-Infective AgentsResumen
Introduction: Bacterial meningitis is a severe infection requiring early empirical therapeutic intervention. In Colombia, there is limited information regarding this disease in the neonatal stage, necessitating up-to-date data to guide timely antibiotic therapy.
Objective: To describe the clinical, microbiological, and epidemiological characteristics of neonatal bacterial meningitis in three hospital centers in the city of Medellín during the years 2010 to 2019.
Methods: A descriptive study was conducted using electronic medical records of newborns treated in three hospitals in Medellín from 2010 to 2019. Clinical records with a discharge diagnosis of bacterial meningitis and corresponding microbiological isolation were reviewed. Data were extracted from SAP® and Servinte Clinical Suite Enterprise® and recorded in a Google® spreadsheet.
Results: A total of 125 records with a diagnosis of neonatal meningitis were reviewed with only 42 cases meeting microbiological isolation criteria.The mean gestational age was 35 weeks, and the most frequentlyisolated pathogens were Escherichia coli (40.5%) and Streptococcus agalactiae (40.5%). In 71.4% of cases, the meningitis was classified as late-onset according to age. Primary symptoms included irritability (56.1%) and fever (48.8%).
Conclusions: The most common causative agents identified in this population were S. agalactiae and E. coli. Principal symptoms were irritability and fever. A significant proportion of neonates did not present suggestive symptoms of central nervous system infection. Additionally, prematurity was predominant in the studied population.
Descargas
Citas
(1) Barichello T, Fagundes GD, Generoso JS, Elias SG, Simoes LR, Teixeira AL. Pathophysiology of neonatal acute bacterial meningitis. J Med Microbiol [Internet]. 2013;62(12):1781–9. DOI 10.1099/jmm.0.059840-0
(2) Pong A, Bradley JS. Bacterial meningitis and the newborn infant. Infect Dis Clin North Am [Internet]. 1999;13(3):711–33. DOI 10.1016/S0891-5520(05)70102-1.
(3) Penagos-Paniagua MJ, Berrón-Pérez RD, García-Cruz LM, Zaragoza-Benítez JM. El sistema inmune del recién nacido. Alergia e Inmunol. Pediátr [Internet]. 2003;12(2):63–8. Disponible en: http://www.medigraphic.com/pdfs/alergia/al-2003/al032e.pdf
(4) Sáez-Llorens X, McCracken GH. Bacterial meningitis in children. Lancet [Internet]. 2003 Jun;361(9375):2139–48. DOI 10.1016/S0140-6736(03)13693-8.
(5) Harvey D, Holt DE, Bedford H. Bacterial meningitis in the newborn: A prospective study of mortality and morbidity. Semin Perinatol [Internet]. 1999 Jun;23(3):218–25. DOI 10.1016/S0146-0005(99)80066-4.
(6) Olmedo-Díaz I, Pallás-Alonso C, Miralles-Molina M, de las Heras RS, Rodríguez-Otero J, Chasco-Irigoyen. Meningitis neonatal: Estudio de 56 casos. An esp pediatr [Internet]. 1997;46(2):189-194. Disponible en: https://www.aeped.es/sites/default/files/anales/46-2-18.pdf
(7) Fitzhardinge PM, Kazemi M, Ramsay M, Stern L. Long-term Sequelae of Neonatal Meningitis. Dev Med Child Neurol [Internet]. 2008 Nov;16(1):3–8. DOI 10.1111/j.1469-8749. 1974.tb02704. x.
(8) Furyk JS, Swann O, Molyneux E. Systematic review: neonatal meningitis in the developing world. Trop Med Int Heal [Internet]. 2011;16(6):672–9. DOI 10.1111/j.1365-3156.2011.02750.x.
(9) Morales-Bedoya, A, Alonso-Palacio LM. Epidemiología de la meningitis Una visión socio-epidemiológica. Salud Uninorte [Internet]. 2006;22(2):105–20. Available from: https://www.redalyc.org/articulo.oa?id=81722206
(10) Chang CJ, Chang WN, Huang LT, Huang SC, Chang YC, Hung PL, et al. Neonatal Bacterial Meningitis in Southern Taiwan. Pediatr Neurol [Internet]. 2003 Oct;29(4):288–94. DOI 10.1016/S0887-8994(03)00273-X.
(11) Stoll BJ. The Global Impact of Neonatal Infection. Clin Perinatol [Internet]. 1997 Mar;24(1):1–21. DOI 10.1016/S0095-5108(18)30181-7.
(12) Thigpen MC, Whitney CG, Messonnier NE, Zell ER, Lynfield R, Hadler JL, et al. Bacterial Meningitis in the United States, 1998–2007. N Engl J Med [Internet]. 2011 May;364(21):2016–25. DOI 10.1056/NEJMoa1005384.
(13) Maalej SM, Kassis M, Mahjoubi-Rhimi F, Damak J, Hammami A. Bactériologie des méningites communautaires dans la région de Sfax, Tunisie (1993-2001). Med Mal Infect [Internet]. 2006 Feb;36(2):105–10. DOI 10.1016/j.medmal.2005.10.011.
(14) Tique V, Alvis N, Parodi R, Bustos A, Mattar S. Meningitis Agudas en Córdoba, Colombia 2002 - 2004. Rev. Salud Pública [Internet]. 2006 May;8:33–46. Disponible en: https://revistas.unal.edu.co/index.php/revsaludpublica/article/view/96112
(15) Otero-Patiño R, Bruges J, Lux AM, Mejía J, Agudelo N, Zapata-Muñoz CT, Hoyos D. Meningitis bacteriana aguda en niños: estudio clínico y bacteriológico en el Hospital Infantil de Medellín. 1988;1(2):69-76. Disponible en: https://revistas.udea.edu.co/index.php/iatreia/article/view/3329/3091
(16) VanDemark M. Acute Bacterial Meningitis: Current Review and Treatment Update. Crit Care Nurs Clin North Am [Internet]. 2013 Sep;25(3):351–61. DOI 10.1016/j.ccell.2013.04.004.
(17) Hernández B, Velasco-Mondragón HE. Encuestas transversales. Salud pública Méx [Internet]. 2000;42(5):447-455. Disponible en: https://saludpublica.mx/index.php/spm/article/view/6263/7482
(18) Thomson J, Sucharew H, Cruz AT, Nigrovic LE, Freedman SB, Garro AC, et al. Cerebrospinal fluid reference values for young infants undergoing lumbar puncture. Pediatrics [Internet]. 2018;141(3): e20173405. DOI 10.1542/peds.2017-3405.
(19) Lyons TW, Cruz AT, Freedman SB, Neuman MI, Balamuth F, Mistry RD, et al. Interpretation of Cerebrospinal Fluid White Blood Cell Counts in Young Infants With a Traumatic Lumbar Puncture. Ann Emerg Med [Internet]. 2017;69(5):622-31. DOI 10.1016/j.annemergmed.2016.10.008.
(20) Lyons TW, Cruz AT, Freedman SB, Arms JL, Aronson PL, Fleming AH, et al. Correction of Cerebrospinal Fluid Protein in Infants with Traumatic Lumbar Punctures. Pediatr Infect Dis J [Internet]. 2017;36(10):1006–8. DOI 10.1097/INF.0000000000001634.
(21) Lewis G, Schweig M, Guillén-Pinto D, Rospigliosi ML. Neonatal meningitis in a general hospital in Lima, Peru, 2008 to 2015. Rev. Perú Med Exp Salud Publica [Internet]. 2017 Apr;34(2):233–8. DOI 10.17843/rpmesp.2017.342.2297.
(22) Guillén-Pinto D, Málaga-Espinoza B, Ye-Tay J, Rospigliosi-López ML, Montenegro-Rivera A, Rivas M, et al. Neonatal meningitis: A multicenter study in Lima, Perú. Rev. Perú Med Exp Salud Publica [Internet]. 2020;37(2):210–9. DOI 10.17843/rpmesp.2020.372.4772.
(23) Krebs VLJ, Costa GAM. Clinical outcome of neonatal bacterial meningitis according to birth weight. Arq Neuropsiquiatr [Internet]. 2007;65(4 B):1149–53. DOI 10.1590/S0004-282X2007000700011.
(24) Kliegman RM, St. Geme JW, Stanton BF, Schor NF. Nelson textbook of pediatrics. 19th ed. Philadelphia: Saunders elsevier; 2013. 659–78 p.
(25) Zimmermann P, Gwee A, Curtis N. The controversial role of breast milk in GBS late-onset disease. J Infect [Internet]. 2017;74(Suppl 1): S34–40. DOI 10.1016/S0163-4453(17)30189-5.
(26) Berardi A, Rossi C, Creti R, China M, Gherardi G, Venturelli C, et al. Group B Streptococcal colonization in 160 mother-baby pairs: A prospective cohort study. J Pediatr [Internet]. 2013;163(4) :1099-104.e1. DOI 10.1016/j.jpeds.2013.05.064.
(27) Berardi A, Rossi C, Lugli L, Creti R, Reggiani MLB, Lanari M, et al. Group b streptococcus late-onset disease: 2003-2010. Pediatrics [Internet]. 2013 Feb;131(2) e361-8. DOI 10.1542/peds.2012-1231.
(28) Allegranzi B, Nejad SB, Combescure C, Graafmans W, Attar H, Donaldson L, et al. Burden of endemic health-care-associated infection in developing countries: Systematic review and meta-analysis. Lancet [Internet]. 2011 Jan;377(9761):228–41. DOI 10.1016/S0140-6736(10)61458-4.
(29) Public Health Agency of Canada. Device-associated infections in Canadian acute-care hospitals from 2009 to 2018. Canada Commun Dis Rep [Internet]. 2020 Nov;46(11-12):387–97. DOI 10.14745/ccdr.v46i1112a05.
(30) Persson E, Trollfors B, Brandberg LL, Tessin I. Septicaemia and meningitis in neonates and during early infancy in the Göteborg area of Sweden. Acta Paediatr Int J Paediatr [Internet]. 2002;91(10):1087–92. DOI 10.1080/080352502760311593.
(31) Azimi T, Mirzadeh M, Sabour S, Nasser A, Fallah F, Pourmand MR. Coagulase-negative staphylococci (CoNS) meningitis: a narrative review of the literature from 2000 to 2020. New Microbes New Infect [Internet]. 2020;37:100755. DOI 10.1016/j.nmni.2020.100755.
(32) Casetta A, Audibert F, Brivet F, Boutros N, Boithias C, Lebrun L. Emergence of nosocomial Pseudomonas aeruginosa colonization/infection in pregnant women with preterm premature rupture of membranes and in their neonates. J Hosp Infect [Internet]. 2003 Jun;54(2):158–60. DOI 10.1016/S0195-6701(03)00121-X.
(33) Giannoni E, Agyeman PKA, Stocker M, Posfay-Barbe KM, Heininger U, Spycher BD, et al. Neonatal Sepsis of Early Onset, and Hospital-Acquired and Community-Acquired Late Onset: A Prospective Population-Based Cohort Study. J Pediatr [Internet]. 2018 Oct;201:106-114.e4. DOI 10.1016/j.jpeds.2018.05.048.
(34) Liu G, He S, Zhu X, Li Z. Early onset neonatal bacterial meningitis in term infants: the clinical features, perinatal conditions, and in-hospital outcomes: A single center retrospective analysis. Medicine (Baltimore) [Internet]. 2020 Oct;99(42): e22748. DOI 10.1097/MD.0000000000022748.
(35) Ponnampalam A, de Sousa P, Carroll W. Recognising early meningitis: a missed opportunity to diagnose meningitis. BMJ Case Rep [Internet]. 2016 Aug;2016:bcr2016214636. DOI 10.1136/bcr-2016-214636.
(36) Mulder CJJ, Zanen HC. A study of 280 cases of neonatal meningitis in The Netherlands. J Infect [Internet]. 1984 Sep;9(2):177–84. DOI 10.1016/S0163-4453(84)91351-3.
(37) Polin RA, Harris MC. Neonatal bacterial meningitis. Semin Neonatol [Internet]. 2001 Apr;6(2):157–72. DOI 10.1053/siny.2001.0045.
(38) Garges HP, Moody MA, Cotten CM, Smith PB, Tiffany KF, Lenfestey R, et al. Neonatal meningitis: What is the correlation among cerebrospinal fluid cultures, blood cultures, and cerebrospinal fluid parameters? Pediatrics [Internet]. 2006;117(4):1094–100. DOI 10.1542/peds.2005-1132.
(39) Ku LC, Boggess KA, Cohen-Wolkowiez M. Bacterial meningitis in infants. Clin Perinatol. [Internet]. 2014;42(1):2345. DOI 10.1016/j.clp.2014.10.004.
(40) Nel E. Neonatal meningitis: Mortality, cerebrospinal fluid, and microbiological findings. J Trop Pediatr [Internet]. 2000;46(4):237–9. DOI 10.1093/tropej/46.4.237.
(41) Lin MC, Chi H, Chiu NC, Huang FY, Ho CS. Factors for poor prognosis of neonatal bacterial meningitis in a medical center in Northern Taiwan. J Microbiol Immunol Infect [Internet]. 2012 Dec;45(6):442–7. DOI 10.1016/j.jmii.2011.12.034.
(42) Tan J, Kan J, Qiu G, Zhao D, Ren F, Luo Z, et al. Clinical Prognosis in Neonatal Bacterial Meningitis: The Role of Cerebrospinal Fluid Protein. PLoS One [Internet]. 2015 Oct 28;10(10):e0141620. DOI 10.1371/journal.pone.0141620.
(43) Klinger G, Chin CN, Beyene J, Perlman M. Predicting the outcome of neonatal bacterial meningitis. Pediatrics [Internet]. 2000;106(3):477–82. DOI 10.1542/peds.106.3.477.
(44) Sturgeon JP, Zanetti B, Lindo D. C-Reactive Protein (CRP) levels in neonatal meningitis in England: An analysis of national variations in CRP cut-offs for lumbar puncture. BMC Pediatr [Internet]. 2018 Dec;18(1)380. DOI 10.1186/s12887-018-1354-x.
(45) Volpe JJ, Inder TE, Darras BT, de Vries LS, du Plessis AJ, Neil JJ, et al. Volpe’s neurology of the newborn [Internet]. Fifth Edit. Saunders, editor. Volpe’s Neurology of the Newborn. Elsevier; 2017. 1–1224 p. Disponible en: https://www.elsevier.com/books/volpes-neurology-of-the-newborn/volpe/978-0-323-42876-7
(46) García-Balaguera C. Obstacles and quality of prenatal care. Rev Fac Med [Internet]. 2017;65(2):305–10. DOI 10.15446/revfacmed.v65n2.59704.
(47) Uc-Cachón AH, Gracida-Osorno C, Luna-Chi IG, Jiménez-Guillermo JG, Molina-Salinas GM. High prevalence of antimicrobial resistance among gram-negative isolated bacilli in intensive care units at a tertiary-care hospital in Yucatán Mexico. Medicina (Kaunas) [Internet]. 2019 Sep;55(9):588. DOI 10.3390/medicina55090588.
(48) Anderson DJ, Jenkins TC, Evans SR, Harris AD, Weinstein RA, Tamma PD, et al. The role of stewardship in addressing Antibacterial resistance: Stewardship and infection control committee of the Antibacterial Resistance Leadership Group. Clin Infect Dis [Internet]. 2017;64(suppl 1):S36–40. DOI 10.1093/cid/ciw830.
(49) Ministerio de Salud y Protección Social. Guía de práctica clínica Recién nacido: sepsis neonatal temprana [Internet]. Colciencias: Bogotá; 2013. Disponible en: https://www.minsalud.gov.co/sites/rid/Lists/BibliotecaDigital/RIDE/INEC/IETS/GPC_Ptes_Sepsis.pdf
(50) Álvarez-Pinzón AM, Rodríguez-Martínez M, Ortiz GC. Actualización en el tratamiento de la meningitis neonatal bacteriana y el reporte de un caso. Revista Med [Internet]. 2010 Jun 30;18(1):100–14. Disponible en: https://revistas.unimilitar.edu.co/index.php/rmed/article/view/1304/1034
Descargas
Publicado
Cómo citar
Número
Sección
Licencia
Derechos de autor 2022 Iatreia

Esta obra está bajo una licencia internacional Creative Commons Atribución-CompartirIgual 4.0.
Los artículos publicados en la revista están disponibles para ser utilizados bajo la licencia Creative Commons, específicamente son de Reconocimiento-NoComercial-CompartirIgual 4.0 Internacional.
Los trabajos enviados deben ser inéditos y suministrados exclusivamente a la Revista; se exige al autor que envía sus contribuciones presentar los formatos: presentación de artículo y responsabilidad de autoría completamente diligenciados.