Gram-negative Enteric Bacillary Meningitis: A Twenty-One-Year Experience

J Pediatr. 1993 Jan;122(1):15-21. doi: 10.1016/s0022-3476(05)83480-8.

Abstract

We reviewed our experience with gram-negative enteric bacillary meningitis in neonates and infants from 1969 through 1989. Ninety-eight patients were identified. Their ages were from 1 day to 2 years with a median of 10 days. In 25 patients (26%), predisposing factors were identified, the most common of which were neural tube defects and urinary tract anomalies. The causative agents were Escherichia coli (53%), Klebsiella-Enterobacter species (16%), Citrobacter diversus (9%), Salmonella species (9%), Proteus mirabilis (4%), Serratia marcescens (3%), Bacteroides fragilis (3%), and Aeromonas species (2%). At the time of diagnosis, Gram-stained smears of cerebrospinal fluid revealed gram-negative bacilli in 61% of patients. The causative organism was cultured from blood obtained from 55% of patients, and 21% had positive urine culture results. The cerebrospinal fluid leukocyte counts ranged from 0 to 80,600 cells/mm3, and the cerebrospinal fluid/serum glucose concentration ratio was less than 0.5 in 72% of patients. Antimicrobial regimens varied greatly. After initiation of antibiotic therapy, an average of 3 days was needed for eradication of bacteria from cerebrospinal fluid. The case-fatality rate was 17%, and 61% of survivors had long-term sequelae that included seizure disorders, hydrocephalus, physical disability, developmental delay, and hearing loss.

MeSH terms

  • Anti-Bacterial Agents
  • Drug Therapy, Combination
  • Enterobacteriaceae Infections / cerebrospinal fluid
  • Enterobacteriaceae Infections / complications
  • Enterobacteriaceae Infections / drug therapy
  • Enterobacteriaceae Infections / epidemiology*
  • Enterobacteriaceae Infections / physiopathology
  • Escherichia coli Infections / epidemiology
  • Humans
  • Hydrocephalus / etiology
  • Infant
  • Infant, Newborn
  • Intellectual Disability / etiology
  • Meningitis, Bacterial / cerebrospinal fluid
  • Meningitis, Bacterial / complications
  • Meningitis, Bacterial / drug therapy
  • Meningitis, Bacterial / epidemiology*
  • Meningitis, Bacterial / physiopathology
  • Muscle Spasticity / etiology
  • Paralysis / etiology
  • Postoperative Complications / epidemiology
  • Postoperative Complications / microbiology
  • Recurrence
  • Risk Factors
  • Seizures / etiology
  • Survival Rate
  • Texas / epidemiology
  • Treatment Outcome

Substances

  • Anti-Bacterial Agents