P624\u2005Hospital-acquired neonatal meningitis: Experience of the Neonatology departemet of sfax (tunisia)

Abstract

Background The past decade brought with it both highly sophisticated neonatal intensive care with improved perinatal mortality rates and increased risk for nosocomial septicemia and meningitis among survivors. Although most of these infections were caused by multiple antibiotic-resistant bacteria. The absence of specific clinical signs makes diagnosis of meningitis more difficult. Methods We enrolled neonates who were admitted to neonatal unit at at Hedi Chaker hospital, Sfax from 1 January 2007 to 31 December 2016 and had suspected nosocomial infection with abnormal cerebrospinal fluid examination. Results Five cases were reviewed, Among these 4 were girls (80%), All neonates were preterm between 27 and 34 weeks of pregnancy, with Low birth weight in 2 cases and very Low birth weight in 3 cases, the average age of diagnosis was 14.2 days after hospitalization, 4 (80%) of them had concomitant bacteremia, suspected bacterial infection was confirmed in 4 cases (80%), by positive results on blood culture in 4 cases but only one cerebrospinal fluid (CSF) culture was positive, Klebsiella pneumoniae was the leading pathogen. The case mortality rate (CMR) was 0.8. Four patients died and one case was cured but he developed a sequellae of psychomotoric retardation. Conclusion Preterm neonates have a high risk of developing nosocomial infections and especially Nosocomial Meningitis wich is related to a high case mortality rate, Definitive diagnosis is made by cerebrospinal fluid examination (CSF) via lumbar puncture (LP), which should be performed in any neonate suspected of having sepsis or meningitis. Future efforts should be directed toward better definition of bacterial virulence, host susceptibility and preventive measures.