Diagnostic accuracy of cerebrospinal fluid lactate in confirmed cases of acute bacterial meningitis in children.

OBJECTIVE: To determine the diagnostic accuracy of cerebrospinal fluid lactate level in confirmed cases of acute bacterial meningitis in children. METHODS: This cross sectional study was conducted in the Department of Paediatrics, King Edward Medical University/ Mayo Hospital, Lahore from January to December 2018. A total of 250 children, between two months - 12 years of age, of both the genders, with suspected acute bacterial meningitis were included by non-probability consecutive sampling. Each child was subjected to lumbar puncture for biochemistry, cytology, culture, and lactate level. CSF lactate level of 1.1-2.4 mmol/L was taken as normal, and >2.4 mmol/L was taken as cut off for acute bacterial meningitis. All collected data was entered and analyzed in SPSS version 22. A 2 x 2 table was made to calculate diagnostic accuracy, sensitivity, specificity, positive and negative predictive value for CSF Lactate. RESULTS: The sensitivity, specificity, positive predictive value, negative predictive value and diagnostic accuracy of CSF lactate taking CSF culture as gold standard was 100%, 60.61%, 17.27%, 100% and 63.6% respectively, with kappa of 0.19 and p value of 0.000. CONCLUSION: At a cut off value of 2.4 mmol/L, cerebrospinal fluid lactate level has a high diagnostic accuracy for acute bacterial meningitis.

Risk factors for candidaemia in neonates with sepsis in a tertiary care hospital in Pakistan.

OBJECTIVE: To determine the risk factors for candidaemia in babies admitted to a tertiary care hospital with neonatal sepsis. METHODS: This nested case control study was conducted in the Neonatal Unit of the department of Paediatrics, King Edward Medical University/Mayo Hospital, Lahore, from January 2017 to June 2018. A total of 350 neonates having sepsis according to the clinical case definition were enrolled in this study by non-probability convenient sampling. Blood culture for bacteria on first day and for candida on fifth day was sent. Patients were started antimicrobial therapy as per institutional policy on admission. All patients were followed for risk factors for development of candidaemia. Data was analyzed by SPSS 22.0, Odds ratio and logistic regression was used to determine the magnitude of risk factors. RESULTS: Among 350 septic neonates, 36 isolates were positive for Candida spp, constituting 10.2% of candidaemia among septic neonates. Necrotizing enterocolitis was found to be the significantly associated risk factor for development of candidaemia. CONCLUSIONS: Necrotizing enterocolitis was found to be an important risk factor for development of candidaemia among hospitalized septic neonates.

The etiology of neonatal sepsis and patterns of antibiotic resistance.

OBJECTIVE: To study the patterns of causative bacteria and antibiotic resistance in neonatal sepsis. DESIGN: Descriptive study. PLACE AND DURATION OF STUDY: Department of Neonatology, The Children s Hospital and the Institute of Child Health, Lahore from July 2000 to December 2000. SUBJECTS AND METHODS: Two hundred and twenty-eight neonates (age 0-28 days) with clinical sepsis and positive blood cultures were selected. Blood cultures were taken before antibiotics (intravenous cefotaxime and amikacin) administration. The clinical and birth records were thoroughly analyzed. Blood culture reports (n=233) were analyzed for bacterial isolates and pattern of resistance to cefotaxime, ceftazidime, amikacin and ciprofloxacin were compared as percentage of reports showing resistance to the above antibiotics. RESULTS: Among 228 cases included in the study, the male to female ratio was 2.1 to 1. The gestational age was less than 36 weeks in 68 (30%) cases and low birth weight babies were 143 (62.6%). History of birth asphyxia was present in 103 (45%) cases. There were 142 (62.3%) cases of early onset (< 7 days) sepsis and 86 (37.7%) cases of late onset (>7 days). Out of 233 positive blood cultures Escherichia coli was found to be commonest (47.8%, n=111, p <0.05) both in early onset (47.8%, n=68, p <0.05) and late onset sepsis (47.3%, n=43, p<0.05). Staphylococcus aureus was the most common among gram positive organism. Resistance to cefotaxime, ceftazidime and amikacin was 34% to 80% and to ciprofloxacin 13% to 72%. A total of 64 cases (28%) died. Mortality was four times higher in early onset sepsis (n=53 vs 11, 47% vs 12%). CONCLUSION: Gram negative bacteria are the commonest cause of neonatal sepsis. The resistance to the commonly used antibiotics is alarmingly high. Mortality is four times higher in early onset sespis.