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Acute bacterial meningitis in children admitted to a rural Kenyan hospital: increasing antibiotic resistance and outcome

Mwangi, I; Berkley, J; Lowe, B; Peshu, N; Marsh, K; Newton, CR; (2002) Acute bacterial meningitis in children admitted to a rural Kenyan hospital: increasing antibiotic resistance and outcome. The Pediatric Infectious Disease Journal , 21 (11) 1042 - 1048.

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Abstract

BACKGROUND: Acute bacterial meningitis (ABM) is an important cause of mortality in Africa, but most studies are based in urban referral hospitals. Poor laboratory facilities make diagnosis difficult, and treatment is limited to inexpensive antibiotics. METHODS: We retrospectively reviewed data from children admitted with ABM to a Kenyan district hospital from 1994 through 2000. We calculated the minimum incidence in children admitted from a defined area. We also examined the antibiotic susceptibility patterns. RESULTS: We identified 390 cases (1.3% of all admissions) of whom 88% were <5 years old. The apparent minimum annual incidence in children younger than 5 years of age increased from 120 to 202 per 100,000 between 1995 and 2000 (P < 0.001). Increasing the lumbar punctures performed by including prostrated or convulsing children significantly increased the number of cases detected (P < 0.005). The most common organisms in infants <3 months were streptococci and Enterobacteriaceae. Streptococcus pneumoniae (43.1%) and Haemophilus influenzae (41.9%) were predominant in the postneonatal period. The overall mortality was 30.1%, and 23.5% of survivors developed neurologic sequelae. Chloramphenicol resistance of H. influenzae rose from 8% in 1994 to 80% in 2000 (P < 0.0001) accompanied by an apparent increase in mortality. A short history, impaired consciousness and hypoglycemia were associated with death. Prolonged coma and low cerebrospinal fluid glucose were associated with neurologic sequelae. CONCLUSION: ABM in rural Kenya is a severe illness with substantial mortality and morbidity. Prognosis could be improved by broadening the criteria for lumbar puncture and use of appropriate antibiotics

Type:Article
Title:Acute bacterial meningitis in children admitted to a rural Kenyan hospital: increasing antibiotic resistance and outcome
Additional information:UI - 22329485 LA - eng RN - 0 (Anti-Infective Agents) PT - Journal Article DA - 20021120 IS - 0891-3668 SB - IM CY - United States
Keywords:1994, 1995, Acute Disease, ADMISSION, Africa, age, Age Factors, AGENT, AGENTS, Anti-Infective Agents, antibiotic, Antibiotic resistance, Antibiotics, Bacteria, BACTERIAL, BACTERIAL MENINGITIS, BACTERIAL-MENINGITIS, CEREBROSPINAL FLUID, CEREBROSPINAL-FLUID, Child, Child, Preschool, children, Chloramphenicol, Coma, COMMON, complications, CONSCIOUSNESS, Consciousness Disorders, CRITERIA, DEATH, DEVELOPED, diagnosis, DIFFICULT, DISTRICT, Drug Resistance, Multiple, Bacterial, drug therapy, Enterobacteriaceae, epidemiology, FACILITIES, Female, fluid, Glucose, Haemophilus, Haemophilus Influenzae, History, Hospital, Hospitalization, HOSPITALS, HYPOGLYCEMIA, ILLNESS, ILLNESSES, IM, improved, Incidence, INCREASE, infant, Infant, Newborn, INFANTS, isolation & purification, Kenya, LA, Laboratories, laboratory, Low, LUMBAR, Male, medicine, MENINGITIS, Meningitis, Bacterial, Methods, microbiology, MORBIDITIES, Morbidity, MORTALITY, Nervous System Diseases, NUMBER, old, outcome, Pattern, PATTERNS, pharmacology, poor, Prognosis, Puncture, Punctures, Resistance, Result, Retrospective Studies, Risk Factors, rural, Rural Health, SEQUELAE, STATE, STATES, Streptococci, Streptococcus, Streptococcus pneumoniae, Support, Non-U.S.Gov't, Survivors, SUSCEPTIBILITY, treatment, united, United States, UNITED-STATES, urban, Use
UCL classification:UCL > School of Life and Medical Sciences > Faculty of Population Health Sciences > Institute of Child Health

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