Rianna Leazer1, Natasha Erickson2, James Paulson3,4, Ronen Zipkin5, Monica Stemmle6, Alan R Schroeder7, Michael Bendel-Stenzel8, Bryan R Fine3. 1. Children's Hospital of The King's Daughters, Norfolk, Virginia; rianna.leazer@chkd.org. 2. St. Luke's Children's Hospital, Boise, Idaho. 3. Children's Hospital of The King's Daughters, Norfolk, Virginia. 4. Children's Hospital of The King's Daughters and Old Dominion University, Norfolk, Virginia. 5. Children's Hospital of Los Angeles, Los Angeles, California. 6. Santa Clara Valley Medical Center, San Jose, California. 7. Lucile Packard Children's Hospital Stanford, Stanford, California; and. 8. Children's Hospital and Clinics of Minnesota, Minneapolis, Minnesota.
Abstract
BACKGROUND: Although meningitis is rare in previously healthy term infants, lumbar puncture is often performed to evaluate for source of illness. This study was performed to determine the time to detection for positive cerebrospinal fluid (CSF) cultures and to provide an update on the current epidemiology of bacterial meningitis in term infants. METHODS: This study was a multicenter, retrospective review of positive CSF cultures in infants ≤90 days of age. Specimens were drawn in the emergency department or inpatient setting between January 2000 and December 2013. Cultures were deemed true pathogens or contaminant species based on the attending physician's treatment plan. Cultures from premature infants, an operative source, or those with significant medical history were excluded. RESULTS: A total of 410 positive CSF culture results were included, with 53 (12.9%) true pathogens and 357 (87.1%) contaminant species. The mean ± SD time to detection for true pathogens was 28.6 ± 16.8 hours (95% confidence interval, 24-33.2); for contaminant species, it was 68.1 ± 36.2 hours (95% confidence interval, 64.3-71.9). Forty-three true-positive cases (81.1%) were positive in ≤36 hours. The most common pathogen was group B Streptococcus (51%), followed by Escherichia coli (13%) and Streptococcus pneumoniae (9%). CONCLUSIONS: The majority of pathogenic bacteria in CSF exhibit growth within 36 hours. Most growth from CSF cultures in febrile infants is treated as contamination. The epidemiology of meningitis has remained constant, with group B Streptococcus as the predominant pathogen, despite changes noted in the epidemiology of bacteremia in this population.
BACKGROUND: Although meningitis is rare in previously healthy term infants, lumbar puncture is often performed to evaluate for source of illness. This study was performed to determine the time to detection for positive cerebrospinal fluid (CSF) cultures and to provide an update on the current epidemiology of bacterial meningitis in term infants. METHODS: This study was a multicenter, retrospective review of positive CSF cultures in infants ≤90 days of age. Specimens were drawn in the emergency department or inpatient setting between January 2000 and December 2013. Cultures were deemed true pathogens or contaminant species based on the attending physician's treatment plan. Cultures from premature infants, an operative source, or those with significant medical history were excluded. RESULTS: A total of 410 positive CSF culture results were included, with 53 (12.9%) true pathogens and 357 (87.1%) contaminant species. The mean ± SD time to detection for true pathogens was 28.6 ± 16.8 hours (95% confidence interval, 24-33.2); for contaminant species, it was 68.1 ± 36.2 hours (95% confidence interval, 64.3-71.9). Forty-three true-positive cases (81.1%) were positive in ≤36 hours. The most common pathogen was group B Streptococcus (51%), followed by Escherichia coli (13%) and Streptococcus pneumoniae (9%). CONCLUSIONS: The majority of pathogenic bacteria in CSF exhibit growth within 36 hours. Most growth from CSF cultures in febrile infants is treated as contamination. The epidemiology of meningitis has remained constant, with group B Streptococcus as the predominant pathogen, despite changes noted in the epidemiology of bacteremia in this population.
Authors: Paul L Aronson; Marie E Wang; Lise E Nigrovic; Samir S Shah; Sanyukta Desai; Christopher M Pruitt; Fran Balamuth; Laura Sartori; Richard D Marble; Sahar N Rooholamini; Rianna C Leazer; Christopher Woll; Adrienne G DePorre; Mark I Neuman Journal: Hosp Pediatr Date: 2018-07
Authors: Eduardo Fleischer; Mark I Neuman; Marie E Wang; Lise E Nigrovic; Sanyukta Desai; Adrienne G DePorre; Rianna C Leazer; Richard D Marble; Laura F Sartori; Paul L Aronson Journal: Hosp Pediatr Date: 2019-11-05
Authors: Paul L Aronson; Marie E Wang; Eugene D Shapiro; Samir S Shah; Adrienne G DePorre; Russell J McCulloh; Christopher M Pruitt; Sanyukta Desai; Lise E Nigrovic; Richard D Marble; Rianna C Leazer; Sahar N Rooholamini; Laura F Sartori; Fran Balamuth; Christopher Woll; Mark I Neuman Journal: Pediatrics Date: 2018-11-13 Impact factor: 7.124
Authors: Elizabeth R Alpern; Nathan Kuppermann; Stephen Blumberg; Genie Roosevelt; Andrea T Cruz; Lise E Nigrovic; Lorin R Browne; John M VanBuren; Octavio Ramilo; Prashant Mahajan Journal: Hosp Pediatr Date: 2020-09