MCINTYRE PB, GILMOUR R, KAKAKIOS AM, GILBERT GL, MELLIS CM; Interscience Conference on Antimicrobial Agents and Chemotherapy.

Abstr Intersci Conf Antimicrob Agents Chemother Intersci Conf Antimicrob Agents Chemother. 1999 Sep 26-29; 39: 679 (abstract no. 1189).

Univ. of Sydney, Sydney, AUSTRALIA

BACKGROUND: Data on the relationship between "occult" pneumococcal bacteraemia (OPB) and pneumococcal meningitis (PM) come from potentially biased hospital series with few cases of PM. We evaluated possible missed opportunities (PMO) for diagnosis in an unselected series of PM cases who were in the age group at risk for OPB.METHODS: PM cases /3 to <36 months of age were identified retrospectively from a comprehensive laboratory and hospital network in a well defined population 1990-98. Standard data were obtained by a single observer (RG) from hospital and practitioner records. PM was defined as isolation of pneumococci from cerebrospinal fluid (CSF) or from blood culture with abnormal CSF.RESULTS: Of 151 PM < 15 years, 100 were previously well children >/= 3 to < 36 months, of whom 48 were PMO (not referred to hospital after first visit to a family practitioner (33), not admitted after first hospital presentation (FHP) (8) or both (7)). White cell count (WCC) and temperature (T) were not recorded prior to FHP and had limited sensitivity for PM by traditional OPB criteria. WCC was < 15 x 10 [9 ]/L in 35% of whole series, 21% of PMO. Only 33% of series and 40% PMO had both T >/= 39 degrees C and WCC >/= 15 x 10 [9 ]/L. Of 15 PM not admitted at FHP, 4 (27%) had WCC < 15 x 10 [9 ]/L, and all 15 returned and were diagnosed within 12 hours. 14 PM did not have lumbar puncture (LP) until blood culture reported +ve, but 13/14 commenced parenteral antibiotic therapy before LP, 10/13 < 8 hrs after FHP. Outcomes for PMO were 1) death in 6/48 (12.5%) vs 4/52 (7.7%) others (P=0.5); 2) deficit at discharge 5/42 (12%) vs 11/38 (29%) others (P= 0.09).CONCLUSIONS: As OPB criteria can be applied only after hospital presentation with PM and outcome of cases who were PMO did not differ significantly from others, rigorous application of OPB protocols is unlikely to improve management of PM.

Publication Types:

• Meeting Abstracts

Keywords:

• Anti-Bacterial Agents
• Australia
• Child
• Humans
• Meningitis, Pneumococcal
• Research
• Sensitivity and Specificity
• Spinal Puncture
• Streptococcus pneumoniae
• diagnosis

Other ID:

• GWAIDS0008847

UI: 102246344

From Meeting Abstracts