Bacterial Aetiology, Associated factors and immediate outcome of Neonatal Meningitis at The University Teaching Hospital, Lusaka

Abstract

Neonatal meningitis is a devastating disease, and its mortality and morbidity is high. At the University Teaching Hospital (UTH) in Lusaka, however, no study has looked specifically at the disease, and controversy exist on whether neonates admitted to the General Paediatric Wards should be treated with the same drugs as those on the Neonatal intensive Care Unit (NICU), or whether born at home or at the institution. Studies, however, have been done in older children. It is of paramount importance to document neonatal sepsis on any neonatal unit from time to time, as the causative organisms differ not only from place to place, but also from time to time on the same unit. Owing to resource constraints, this is not done at UTH. The study was undertaken to determine the magnitude of neonatal bacterial meningitis, its aetiology and sensitivity patterns, associated factors and immediate outcome in neonates admitted to the General Paediatric Wards and the Neonatal Intensive Care Unit of the University Teaching Hospital, Lusaka. It was also to suggest a possible treatment regimen. This was a descriptive prospective study of neonates with a clinical diagnosis of neonatal sepsis admitted to UTH in the General Paediatric Wards (Group 1) and the NICU (Group 2) from 1st March 2002 to 28th February 2003. Group 1 has about 22 000 admissions per year while Group 2 about 3 000 per year. The neonates were recruited to the study by consecutive sampling. The clinical features and microbiology findings of the twenty-two neonates with meningitis are presented. Eight of these neonates are from Group 1 and 14 from Group 2. The prevalence in Group 1 was 5.6% and that in Group 2 was 4.6%, overall prevalence being 5%. Klebsiella pneumonia (32%) and streptococcus pneumonia (22.7%) were the commonest organisms isolated. Some isolates of K. pneumonia showed resistance to ampicillin chlomphenicol and cefotaxime, whilst one isolate was sensitive to gentamicin. Streptococcus pneumonia was 100% sensitive to chloramphenicol and 80%o sensitive to benzyl penicillin but 25% of the isolates were resistant to cefotaxime. All isolates were fully sensitive to ciprofloxacin. The mean age at diagnosis of neonates in Group 1 was 11.1 days and 3.8 days in Group 2. This was statistically different,/) = 0.0142357. There was no statistical difference in the 2 groups with regard to clinical features and the microbiology findings. In this study, the prevalence of neonatal meningitis in neonates admitted with clinical sepsis to UTH was found to be 0.05. The most prevalent organism isolated was K. pneumonia followed by S. pneumonia and some isolates were resistant to cefotaxime. According to the culture sensitivities in this study, empirical treatment with ciprofloxacin is the appropriate first line of treatment in all neonates with suspected meningitis or sepsis.