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首页> 外文期刊>The East African medical journal >Neonatal bacterial meningitis at the Newborn Unit of Kenyatta National Hospital.
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Neonatal bacterial meningitis at the Newborn Unit of Kenyatta National Hospital.

机译：肯雅塔国家医院新生儿科的新生儿细菌性脑膜炎。

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BACKGROUND: Meningitis occurs in up to one third of neonates with septicaemia. Diagnosis is difficult due to its non-specificity of signs and symptoms. While neonatal septicaemia is a common problem at Kenyatta National Hospital (KNH), there are no recent data on the incidence and clinical characteristics of neonatal meningitis at the hospital. OBJECTIVE: To evaluate the prevalence and the bacterial aetiology of meningitis in neonates at the Newborn Unit (NBU) of KNH. DESIGN: Descriptive cross-sectional study. SETTING: Newborn Unit of Kenyatta National Hospital, Nairobi, Kenya. SUBJECTS AND METHODS: Lumbar punctures were performed on eighty-four neonates with suspected sepsis based on specified clinical criteria. Cases were defined as meningitis if the cerebrospinal fluid (CSF) was positive for bacteria by Gram stain, aerobic bacterial culture or latex particle agglutination assay. RESULTS: The prevalence of meningitis amongst cases of suspected sepsis was 17.9%. The male:female ratio was 1.5:1 mean birth weight 2116.7 grams (1682.2-2551.2) mean gestational age 35.7 weeks (32.6-38.8) and the mean postnatal age was 4.1 days (2.7-5.4) with none of the parameters being significantly different from those without meningitis. Feed intolerance and lethargy were the most common clinical features, present in 73.3% and 60% of patients with meningitis respectively. Neonates with meningitis had a higher mean CSF protein value (2.67 g/L vs 1.97 g/L, p=0.367) and a significantly higher mean CSF white cell count (21 cells/mL vs 7 cells/mL, p=0.001). The most common aetiological agents were Escherichia coli (46.7%). Group B. Streptococci (26.7%) and Klebsiella pneumoniae (13.3%). Most blood and CSF isolates were resistant to ampicillin and gentamicin but showed good in-vitro sensitivities to amikacin, cefuroxime and the third generation cephalosporins (ceftriaxone, ceftazidime and cefotaxime). Blood cultures were positive in only 53.3% of neonates with meningitis. CONCLUSION: Neonatal bacterial meningitis is an important clinical problem at KNH with a prevalence of 17.9% amongst cases of suspected sepsis. E. coli and Group B Streptococci were the most common aetiological pathogens. Blood cultures were negative in almost half of the patients with meningitis. Resistance to the commonly employed first-line antibiotics (penicillin and gentamicin) is high and a change of empirical antibiotic use for neonates with suspected sepsis is recommended.
机译：背景：脑膜炎发生在多达三分之一的败血病新生儿中。由于体征和症状的非特异性，诊断困难。虽然新生儿败血症是肯雅塔国家医院（KNH）的普遍问题，但该医院尚无关于新生儿脑膜炎的发病率和临床特征的最新数据。目的：评估KNH新生儿部门（NBU）新生儿的脑膜炎患病率和细菌病原学。设计：描述性横断面研究。地点：肯尼亚内罗毕肯雅塔国家医院的新生儿科。研究对象和方法：根据指定的临床标准，对疑似脓毒症的84例新生儿进行了腰椎穿刺。如果脑脊液（CSF）通过革兰氏染色，需氧细菌培养或乳胶颗粒凝集测定对细菌呈阳性，则将病例定义为脑膜炎。结果：在怀疑为败血症的病例中脑膜炎的患病率为17.9％。男女比例为1.5：1，平均出生体重2116.7克（1682.2-2551.2），平均胎龄为35.7周（32.6-38.8），平均出生年龄为4.1天（2.7-5.4），所有参数均无显着差异那些没有脑膜炎的人。饲料不耐受和嗜睡是最常见的临床特征，分别在脑膜炎患者中占73.3％和60％。患有脑膜炎的新生儿具有较高的平均CSF蛋白值（2.67 g / L对1.97 g / L，p = 0.367）和较高的平均CSF白细胞计数（21个细胞/ mL对7个细胞/mL，p=0.001）。最常见的病原体是大肠杆菌（46.7％）。 B组：链球菌（26.7％）和肺炎克雷伯菌（13.3％）。大多数血液和脑脊液分离株对氨苄西林和庆大霉素具有抗药性，但对阿米卡星，头孢呋辛和第三代头孢菌素（头孢曲松，头孢他啶和头孢噻肟）表现出良好的体外敏感性。只有53.3％的脑膜炎新生儿的血培养呈阳性。结论：新生儿细菌性脑膜炎是KNH的重要临床问题，在可疑败血症中占17.9％。大肠杆菌和B组链球菌是最常见的病原体。在几乎一半的脑膜炎患者中，血培养为阴性。对常用的一线抗生素（青霉素和庆大霉素）的耐药性较高，建议对怀疑患有败血症的新生儿改变经验性抗生素的使用。

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