© Borgis - New Medicine 1/2001, s. 5-9
Zofia Rajtar-Leontiew1, Teresa Wernik2
The aetiology of cns bacterial infections in neonates, infants, and children hospitalised in the Clinical Hospital of the Medical University of Warsaw between 1988-1998
1Department of Naonatal Pathology, the Medical University of Warsaw
Head: Zofia Rajtar-Leontiew
2Bacteriological Laboratory, Clinical Hospital, the Medical University of Warsaw
Head: Teresa Wernik
Summary
The authors discuss the aetiology of CNS bacterial infections in neonates, infants, and children. The results of this investigation are presented in eight tables.
Bacterial meningitis occurs in children at every age, and is most frequently due to septicaemia, although it is not always easy to confirm the disease on bacteriological examination (15).
The younger the child, the lower the sensitivity of bacterial strains causing the disease, and the more postponed the treatment, the poorer the prognosis as to survival and complete recovery (9, 10).
The absence of bacteriological evidence renders the situation difficult for the patient, since the treatment is based only on morphological and chemical assessment of the cerebrospinal fluid, a physician´s experience and intuition, and nonspecific laboratory parameters (ESR, a complete blood count, platelets, leukocytosis, young forms/ /neutrophils ratio, coagulations system, CRP) (1, 2).
Complications following previous, inappropriately - diagnosed and inadequately - treated bacterial meningitis are difficult to predict, but they are always associated with the child´s further vital physical and intellectual development (9).
The culture growth of bacteria causing meningitis, precise evaluation of their sensitivity and resistance to popular antibiotics, and preserving them for further investigations are the factors which contribute to a targeted treatment, an efficient control of the infection, and a better prognosis (8).
An efficient microbiological laboratory obtains a higher percentage of culture yields if their co-operative with clinicians is more effective. This is expressed as an adequate exchange of information about a patient, appropriate collection of material for study and handing it over to the examiner (according to accepted rules) and on the other hand, the results are immediately interpreted and sent back to the physicians.
At the Clinical Hospital Bacteriological Laboratory over a period of 10.5 years (from the beginning of 1988 until the end of July 1998) positive bacteriological results from CSF examinations were obtained in 115 patients with meningitis. (Detailed data are shown in Table 1). As can be seen from the data, approximately 30% of cases of meningitis in children were caused by N. meningitidis, 14% jointly by S. epidermidis and S. aureus, 11% by all streptococcal groups(Streptococcus spp), and 8% by H. influenzae. The results are similar to the national figures reported by Grzybowska (6).
Table 1. Incidence of bacterial meningitis in children.
| No. | Pathogen/years | 1988 | 89 | 90 | 91 | 92 | 93 | 94 | 95 | 96 | 97 | 98 | Total | % |
| 1. | N. meningitidis | 8 | 8 | 4 | 4 | 1 | 2 | 1 | 1 | 3 | 1 | 1 | 34 | 29.6 |
| 2. | E. coli | | 2 | 1 | 1 | 1 | 2 | 2 | 1 | 1 | | | 11 | 9.6 |
| 3. | H. influenzae | | 1 | 1 | 1 | | | 1 | 1 | 1 | | 3 | 9 | 7.8 |
| 4. | S. epidermidis | | | | 1 | 3 | | 2 | 1 | 1 | 1 | | 9 | 7.8 |
| 5. | S. pneumoniae | | | 1 | 1 | | 1 | 1 | 1 | 2 | | | 7 | 6.0 |
| 6. | S. aureus | 2 | | | | 2 | 1 | 1 | | 1 | | | 7 | 6.0 |
| 7. | P. aeruginosa | 1 | 1 | | | 1 | | 1 | 1 | | | | 5 | 4.3 |
| 8. | E. cloacae | | 2 | | | | 1 | | | 1 | | 1 | 5 | 4.3 |
| 9. | S. agalactiae (B) | | | 1 | | | 1 | | | | 2 | | 4 | 3.5 |
| 10. | C. albicans | 1 | 2 | | | 1 | | | | | | | 4 | 3.5 |
| 11. | L. monocytogenes | | | | | | 1 | | 2 | 1 | | | 4 | 3.5 |
| 12. | S. marcescens | | | 1 | | 1 | 1 | | | | | | 3 | 2.6 |
| 13. | K. pneumoniae | | | | | | 1 | 1 | | | 1 | | 3 | 2.6 |
| 14. | P. mirabilis | | | 1 | | 1 | | | | | | | 2 | 1.7 |
| 15. | Strept. Spp. | | | | | | | 1 | 1 | | | | 2 | 1.7 |
| 16. | P. morgani | 1 | | | | | | | | | | | 1 | 0.9 |
| 17. | P. cepacia | 1 | | | | | | | | | | | 1 | 0.9 |
| 18. | Citrob. freundi | | | | | 1 | | | | | | | 1 | 0.9 |
| 19. | Citrob. intermed. | | | | | | | | | | 1 | | 1 | 0.9 |
| 20. | Flavobact. breve | | | | | | 1 | | | | | | 1 | 0.9 |
| 21. | Acinobact. baumani | | | | | | | | | | 1 | | 1 | 0.9 |
| Total | 14 | 16 | 10 | 8 | 12 | 12 | 11 | 9 | 11 | 7 | 5 | 115 | 100.0 |
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Piśmiennictwo
1. Berger Ch, et al.: Comparison of C-reactive protein and white blood cell count with differential in neonates at risk of septicaemia, Eur J Pediatr 1995, 154:138-144. 2. Eichenwald H: Nene Vorstellungen zur Pathophysiologie der bakteriellen Meningitis, Monatsschr Kinderheilkd 1994, 142:476-481. 3. Fasano C, et al.: Fluconazole treatment of neonates and infants with severe fungal infections not treaTable with conventional agents Eur J Clin Microbiol Infect Dis 1994, 13:351-54. 4. Galazka A.: Choroby wywolane przez paleczki Haemophilus influenzae typu B (HIB), Przegl Ped 1998, 28, 3:176-180. 5. Greenberg D, et al.: A prospective study of neonatal sepsis and meningitis in Southern Israel, Pediatr Infect Dis J 1997, 16:768-73. 6. Grzybowska W, Tyski S: Etiologia bakteryjnych zakazen OUN w Polsce, Mater. Nauk XXIII Zjazdu Pol Tow Mikrobiologów, Lód z 1996, 264. 7. Kowalewska-Kantecka B. i in.: Grzybicze zakazenie OUN z uwzglednieniem zmian patomorfologicznych, Ped Pol 1993, LXVIII, 6:23-28. 8. Rajtar-Leontiew Z. i wsp.: Listerioza jako problem kliniczny i diagnostyczny, Nowa Ped 1997, 1:13-15. 9. Rajtar-Leontiew Z. i wsp.: Zakazenie paciorkowcem grupy B u noworodków i niemowlat, Nowa Ped 1998, 1:8-10. 10. Sundaresan R, Sheagren J: Wspólczesne pojmowanie i leczenie posocznicy, Wektory Medycyny 1998, 1:35-45.
