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      Características clínicas, epidemiológicas y manejo terapéutico de la meningitis pediátrica en dos instituciones de Medellín, Colombia Translated title: Clinical, epidemiological characteristics and therapeutic management of pediatric meningitis in two institutions of Medellin, Colombia

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          Abstract

          Resumen Introducción: La meningitis es una emergencia médica que requiere diagnóstico y tratamiento oportuno para evitar complicaciones. Objetivo: Determinar las características clínicas, epidemiológicas y el manejo terapéutico de meningitis en la primera infancia. Materiales y métodos: Estudio transversal que evaluó menores hasta los seis años de edad con meningitis bacteriana o aséptica en dos centros de Medellín, 2010 - 2013. Se recolectaron características clínicas, paraclínicas y terapéuticas. Las variables cualitativas se describieron mediante frecuencias absolutas y relativas y las cuantitativas con mediana y rango intercuartílico. Se exploró diferencias en las características de los pacientes según grupo de edad, mediante la prueba Chi-cuadrado o Fisher. Resultados: De 56 pacientes, 33 (58,9%) eran del sexo masculino; 26 (46,4%) presentaron meningitis bacteriana, 20 (35,7%) aséptica y 10 (17,9%) indeterminada; 36 (64,3%) fueron mayores de dos meses, con manifestaciones clínicas inespecíficas (fiebre e irritabilidad). Se aislaron principalmente microorganismos Gram negativos en hemocultivos y Gram positivos en líquido cefalorraquídeo. El tratamiento antibiótico más frecuente fue cefalosporinas de tercera-generación en 13 (65%) menores de 2 meses y 28 (77,8%) mayores. Fallecieron dos pacientes y seis presentaron complicaciones. Conclusiones: la meningitis bacteriana fue la más frecuente en menores de un año. El tratamiento combinado es ideal para garantizar un adecuado cubrimiento y evitar complicaciones.

          Translated abstract

          Abstract Introduction: Meningitis is a medical emergency that requires early diagnosis and treatment to avoid complications. Objective: To determine the clinical, epidemiological characteristics and therapeutic management of meningitis in early childhood. Materials and methods: A cross-sectional study, which evaluated children up to six years old with bacterial or aseptic meningitis from 2010 to 2013, was conducted in two centers in Medellin. Clinical, paraclinical and therapeutic characteristics were collected. The qualitative variables were described by absolute and relative frequencies, and the quantitative ones with median and interquartile range. Differences in patient characteristics according to age group were explored, using the Chi-square or Fisher test. Results: From the 56 patients studied, 33 (58.9%) were male; 26 (46.4%) showed bacterial meningitis, 20 (35.7%) aseptic one and 10 (17.9%) indeterminate one; 36 (64.3%) were older than two months, with non-specific clinical manifestations (fever and irritability). Gram-negative microorganisms were mainly isolated in blood cultures and Gram positive in cerebrospinal fluid. The most common antibiotic treatment was third-generation cephalosporins in 13 (65%) children who were less than 2 months and 28 (77.8%) in older ones. Two patients died and six children presented complications. Conclusions: Bacterial meningitis was the most frequent in children under one year old. Combined treatment is ideal to ensure adequate coverage and avoid complications.

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          Most cited references 29

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          Corticosteroids for acute bacterial meningitis.

          In experimental studies, the outcome of bacterial meningitis has been related to the severity of inflammation in the subarachnoid space. Corticosteroids reduce this inflammatory response.
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            Antibiotic treatment delay and outcome in acute bacterial meningitis.

            To identify to what degree in-hospital delay of antibiotic therapy correlated to outcome in community acquired bacterial meningitis. All cases of culture-positive cerebrospinal fluids in east Denmark from 2002 to 2004 were included. Medical records were collected retrospectively with 98.4% case completeness. Glasgow Outcome Scale was used. Multiple regression outcome analyses included the hypothesised factors: delay of therapy, age, bacterial aetiology, adjuvant steroid therapy, coma at admission and the presence of risk factors. One hundred and eighty seven cases were included. Adult mortality was 33% and the proportion of unfavourable outcome in adults was 52%, which differed significantly from that of children (<18 years) with a mortality of 3% (OR=15.8, 95% confidence interval: 3.7-67.6) and an unfavourable outcome of 14% (OR=12.7, CI: 4.3-37.2). Delay of antibiotic therapy correlated independently to unfavourable outcome (OR=1.09/h, CI: 1.01-1.19) among the 125 adult cases. In the group of adults receiving adequate antibiotic therapy within 12h (n=109), the independent correlation between antibiotic delay and unfavourable outcome was even more prominent (OR=1.30/h, CI: 1.08-1.57). The median delay to the first dose of adequate antibiotics was 1h and 39min (1h and 14min in children vs. 2h in adults, p<0.01), and treatment delay exceeded 2h in 21-37% of the cases with clinically evident meningitis. The delay in antibiotic therapy correlated independently to unfavourable outcome. The odds for unfavourable outcome may increase by up to 30% per hour of treatment delay.
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              Acute bacterial meningitis in infants and children

               KS KIM,  KS Kim (2010)
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                Author and article information

                Contributors
                Role: ND
                Role: ND
                Role: ND
                Role: ND
                Role: ND
                Journal
                reus
                Universidad y Salud
                Univ. Salud
                Universidad de Nariño (Pasto, Nariño, Colombia )
                0124-7107
                August 2018
                : 20
                : 2
                : 121-130
                Affiliations
                Medellín orgnameUniversidad Pontificia Bolivariana orgdiv1Facultad de Medicina Colombia
                Medellín orgnameUniversidad Pontificia Bolivariana orgdiv1Facultad de Medicina orgdiv2Semillero de Investigación Colombia
                Article
                S0124-71072018000200121
                10.22267/rus.182002.116

                This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.

                Page count
                Figures: 0, Tables: 0, Equations: 0, References: 37, Pages: 10
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