Guidelines for the management of suspected and confirmed bacterial meningitis in Canadian children older than one month of age Flashcards Preview

CPS Statements > Guidelines for the management of suspected and confirmed bacterial meningitis in Canadian children older than one month of age > Flashcards

Flashcards in Guidelines for the management of suspected and confirmed bacterial meningitis in Canadian children older than one month of age Deck (28):
1

What are common pathogens for community-acquired bacterial meningitis in healthy immunized children >1mo?

1. Streptococcus pneumonia
2. Neisseria meningitidis
3. Streptococcus agalactiae (i.e. GBS) - consider in infants up to 3mo
5. E coli - consider in infants up to 3mo
6. Hemophilus influenza - non typable, and occasionally Hib in non-immunized children

2

What is the criteria for penicillin susceptibility in S. pneumoniae?

1. Penicillin susceptible = MIC <0.06ug/mL penicillin

2. Penicillin resistant if MIC >0.12ug/mL

3

What are Canadian susceptibility patterns?

1. S. pneumoniae ~20% resistant to penicillin and ~2% resistant to ceftriaxone

2. N meningitidis
18.6% resistant to penicillin

3. Hib
4-42% resistant to ampicillin

4

What are signs and symptoms of meningitis?

Infant
1. Fever
2. Poor feeding
3. Lethargy esp. progressive
4. Emesis
5. Irritability esp. prolonged or worsening
6. Rash
7. Inconsolable crying
Older child
1. Nuchal rigidity
2. Headache
3. Impaired consciousness

5

What should be done to diagnose meningitis?

LP for CSF analysis (cell count, glucose, protein, microbiology culture, viral studies, bacterial DNA testing)

6

What are contraindications to a LP?

1. Coagulopathy
2. Cutaneous lesions at the proposed puncture site
3. Signs of herniation
4. Unstable clinical status such as shock

7

When should an LP be deferred until imaging (contrast CT or MRI head) can be performed?

1. Papilledema
2. Focal neurological signs
3. Decreased LOC
4. Coma

8

When should empirical antimicrobial therapy be given?

Do not delay for imaging or LP if will take awhile
Blood culture prior to antimicrobial therapy start

9

What is the minimum blood volume required for a blood culture?

2 mL for a child weighing 1.5 kg to <4 kg;
4 mL for a child weighing 4 kg to <8 kg;
6 mL for a child weighing 8 kg to <14 kg;
10 mL for a child weighing 14 kg to <19 kg;
16 mL for a child weighing 19 kg to <26 kg; and
20 mL for a child weighing >26 kg

10

When should a urine culture, pharyngeal culture or CXR be done?

As clinically indicated

11

What are poor prognostic factors?

1. Delay in start of antimicrobial therapy
2. Severity of clinical state at presentation
3. Isolation of non-penicllin susceptible S pneumoniae

12

When should Listeria coverage (ampicillin) be added?

Underlying immunodeficiency

13

What is the recommended empirical treatment pending blood and CSF culture?

Ceftriaxone OR cefotaxime AND vancomycin ADD ampicillin to cover Listeria if patients are at risk because they are immunocompromised

14

What is the recommended empirical treatment if blood and CSF cultures are negative or not performed but a diagnosis of bacterial meningitis is supported by clinical course and laboratory investigations?

Ceftriaxone OR cefotaxime, without vancomycin* *Vancomycin could be continued if there is local epidemiological evidence of third-generation cephalosporin resistance of Streptococcus pneumoniae

15

What is the recommended treatment for penicillin susceptible S pneumoniae?

1. Penicillin G or ampicillin
2. Alternative: cefotaxime OR ceftriaxone

16

What is the recommended treatment for penicillin resistant AND ceftriaxone or cefotaxime susceptible S pneumoniae?

1. Ceftriaxone OR cefotaxime
2. Alternative: Meropenem

17

What is the recommended treatment for penicillin resistant AND ceftriaxone or cefotaxime intermediate or fully resistant (MIC >1ug/mL) S pneumoniae?

1. Ceftriaxone OR cefotaxime AND vancomycin and consult an ID expert
2. Alternative: Meropenem

18

What is the recommended treatment for penicillin susceptible Neisseria meningitidis?

1. Penicillin G or ampicillin
2. Alternative: cefotaxime OR ceftriaxone

19

What is the recommended treatment for penicillin resistant Neisseria meningitidis?

Ceftriaxone OR cefotaxime

20

What is the recommended treatment for ampicillin susceptible Haemophilus influenzae?

Ampicillin

21

What is the recommended treatment for ampicillin resistant Haemophilus influenzae?

Ceftriaxone or cefotaxime

22

What is the recommended treatment for Streptococcus agalactiae (GBS)?

Penicillin G or ampicillin; ADD gentamicin for the first 5 to 7 days or until cerebrospinal fluid sterility confirmed

23

What is the recommended treatment for other organisms?

Consult an ID expert

24

What is the recommendations re: steroids?

Give dexamethasone 0.6mg/kg/day IV QID administered with or within 30min of the first dose of antimicrobials
If S. pneumoniae or Hib continue for total of 48h, otherwise d/c

25

What do steroids do?

prevent hearing loss in children with acute bacterial meningitis caused by Hib

26

What are the recommendations re: repeat CSF sampling?

Not recommended usually
GBS meningitis consider at 24-48h post initiation of therapy
E coli (gram negative enteric pathogens) repeat CSF culture at 24-48h

27

What is the recommended duration of therapy with IV antibiotic therapy?

1. S pneumoniae 10-14d
2. Hib 7-10d
3. N meningitidis 5-7d
4. GBS 14-21d

28

When should routine formal audiology assessment occur in children with diagnosis of bacterial meningitis?

Before discharge or within one month of discharge

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