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Bacterial meningitis  in babies, establishing standards of care to improve the outcome. Dr  Ifeanyichukwu Okike Clinical Research Fellow Child Health & Vaccine Institute St. George`s, University of London. MRF Meningitis Symposium, Bristol 16 June 2011
Neonatal bactertial meningitis ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Bacterial meningitis Image from Encyclopedia of health
Incidence of neonatal bacterial meningitis ~ 250 cases / year in the UK
Bacterial causes of meningitis in neonates (1996-97) ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Mortality ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Disability at 5 years of age BMJ 2001;323:1-5; Eur J Pediatr 2005;164:730–4 1985-7 n = 274 1996-7 n = 166 severe 7% 5% moderate 18% 18% mild 24% 26% none 50% 51%
Long term consequences of meningitis in very premature babies ,[object Object],[object Object],[object Object],JAMA 2004;292:2357-2365
What are the signs & symptoms? ,[object Object],[object Object],[object Object],[object Object],[object Object],*Infectious Diseases of the Fetus and Newborn Infant. 6 ed. Philadelphia:, Elsevier Saunders; 2006. 247-95.
How is it diagnosed? ,[object Object],[object Object],[object Object],[object Object],[object Object]
How is it diagnosed? ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Neonatal meningitis: how is it diagnosed? ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
How should it be treated if it is suspected? ,[object Object],[object Object],[object Object],Based on 143 cases where a bacteria was isolated from CSF.  Holt et al (2001) Organism %  Group B  Streptococcus 48 Escherichia coli 18 S. pneumoniae 6 Listeria monocytogenes 5 Neisseria meningitidis 4 H. influenzae <1 Other Gram +ve 12 (1 S aureus, 2 S epi) Other Gram -ve 8 (6 on NNU)
Empiric antibiotic therapy ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Note of concern: Neonatal infections in Asia ,[object Object],[object Object],[object Object],[object Object]
Neonatal meningitis: Empiric antibiotic therapy:  Listeria ,[object Object],[object Object],[object Object],[object Object],[object Object]
Neonatal meningitis: Empiric antibiotic therapy:  what are UK Neonatologist currently doing? ,[object Object],[object Object],[object Object],[object Object],Journal of Antimicrobial Chemotherapy (2008) 61, 743–745
Which antibiotic is best? how long should antibiotics be given for?   ,[object Object],[object Object],[object Object]
Neonatal meningitis: what about new antibiotics? ,[object Object],[object Object],[object Object]
Adjunctive therapy ,[object Object],[object Object],[object Object],[object Object],[object Object]
Neonatal meningitis:  what about better early management?  Factors  that predict poor outcome ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Improving the outcome from neonatal infection ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Neonatal meningitis how can we do better? ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
How can we do better? ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Bacterial meningitis in babies <90 days of age: defining the current burden of disease and identifying opportunities for improving the outcome.  (NeoMen) ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Methodology  Other Sources Health Protection Agency Meningitis Support Charities Parents
RESULTS
Summary ,[object Object],[object Object],[object Object]
Acknowledgements ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
A BIG THANK YOU!

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Okike for web

  • 1. Bacterial meningitis in babies, establishing standards of care to improve the outcome. Dr Ifeanyichukwu Okike Clinical Research Fellow Child Health & Vaccine Institute St. George`s, University of London. MRF Meningitis Symposium, Bristol 16 June 2011
  • 2.
  • 3. Bacterial meningitis Image from Encyclopedia of health
  • 4. Incidence of neonatal bacterial meningitis ~ 250 cases / year in the UK
  • 5.
  • 6.
  • 7. Disability at 5 years of age BMJ 2001;323:1-5; Eur J Pediatr 2005;164:730–4 1985-7 n = 274 1996-7 n = 166 severe 7% 5% moderate 18% 18% mild 24% 26% none 50% 51%
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  • 26. Methodology Other Sources Health Protection Agency Meningitis Support Charities Parents
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  • 30. A BIG THANK YOU!

Hinweis der Redaktion

  1. important role for non-culture methods of detection (PCR) – 62 cases with preRx: +ve culture 29%, +ve PCR 58% (J infect Chemother 2009; 15:92-8)