Baterial Meningitis in Children at Maharat Nakhon Ratchasima Hospital : a 5-year Review

Abstract

          Background: Bacterial meningitis is a serious problem in children. In Maharat Nakhon Tatchasima Hospital, there has never been previous study about bacteria sofar. Objective: To study the causative bacteria of meningitis, the pattern of sensitivity in culture positive organism, especially in H. influenzae and S. pneumoniae and acute complications during hospitalization. Patients & Methods: Cases of un enigitis admitted during 1 January 2000-31 December 2004 Pediatric department were reviewed, 0-15 yrs. Results: Seventy-five were enrolled in this study and there were 46 bacterial meningitis, 27 aseptic meningitis, 1 eosinophilic meningitis and 1 ungroupable. In bacterial meningitis group, H. influenzae was the most common causative agent (19.6 %), S. pneumoniae was the second (13%) and E. coli was the third. H. influenzae resisted to ampicillin 25% and S. pneumoniae resisted to penicillin 75%. However, the minimum inhibitory concentration of these organism to cefotaxime was < 0.5 mg/ml, so high dose cefotaxime was effective. In this study, one patient died because of S. pneumoniae septicemia and disseminated intravascular coagulopathy. Another 18 cases had acute complications during hospitalization such as subdural collection 11 cases, hydrocephalus 5 cases, cerebritis & empyema and syndrome of inappropriate anti-diuretic hormone 3 cases, pneumonia 2 cases and ventriculitis 1 case. This study revealed that C-reactive protein was more predictive in aseptic meningitis rather than bacterial one. Conclusion: H. influenza, S. pneumoniae and E. coli  were the major causes of bacterial meningitis in children at Maharat Nakhon Ratchasima Hospital. Concerning to drugs resistant, S. pneumoniae resisted to penicillin at intermediated level.