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Revista Cubana de Pediatría

Print version ISSN 0034-7531

Abstract

DIAZ ALVAREZ, Manuel. Categories of bacterial meningitis risk and antibiotic treatment for neonates with cerebrospinal fluid pleocytosis. Rev Cubana Pediatr [online]. 2014, vol.86, n.1, pp.26-40. ISSN 0034-7531.

Introduction: recently, the neonatal bacterial meningitis predicting model was developed and validated, which provides an effective tool in medical decision-making to prescribe antibiotic treatment to neonates with cerebrospinal fluid pleocytosis. Objective: to find out retrospectively the procedure to indicate the antibiotic treatment for neonates with cerebrospinal fluid pleocytosis prior to the development of the stated model, and to strengthen and substantiate an antibiotic treatment strategy, based on our neonatal bacterial meningitis prediction model of a newborn with cerebrospinal fluid pleocytosis. Methods: retrospective and implemented study of 290 neonates with probable infection; 44 had bacterial meningitis and 246 aseptic meningitis. They were all admitted to the neonatology service of "Juan Manuel Marquez" pediatric hospital from February 1992 to December 2009. The effectiveness of the neonatal bacterial meningitis prediction model was verified, which allowed classifying the patients into high or low bacterial meningitis risk. The indication and the reasons for antibiotic treatment of a neonate with cerebrospinal fluid pleocytosis were retrospectively determined, as well as the analysis of the association of different clinical circumstances such as the classification of severe bacterial infection risk was made. Results: the neonatal bacterial meningitis prediction model showed negative sensitivity and predictive value of 100 % for the bacterial meningitis. There was statistically significant agreement of the model prediction and the classification of severe bacterial infection risk. The rational use of antibiotic treatment was confirmed, since it was immediately applied to 100 % of cases after the diagnosis of bacterial meningitis, but just in one fourth of neonates with aseptic meningitis. The main causes of indication in cases of aseptic meningitis were suspected bacterial meningitis results of the cerebrospinal fluid test, which were not rated as positive in the model, and positive findings for high risk according to the risk of severe bacterial infection criteria. Conclusions: the indication of antibiotic treatment was pretty rational, but unnecessary in some cases. The suggested model facilitates and endorses the indication of antibiotic treatment when there is high risk of bacterial meningitis and also reliably restricts its application when low risk of bacterial meningitis is predicted, although there might be exceptional clinical situations that warrant it temporarily.

Keywords : newborn; bacterial meningitis; aseptic meningitis; prediction model; severe bacterial infection; cerebrospinal fluid.

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