Bacterial Meningitis Flashcards
Most common organisms for bacterial meningitis in patients <1 month
GBS
E. coli
Listeria
Klebsiella
All can be transferred from the mother to the baby
Most common organisms for bacterial meningitis in patients 1-23 months
S. pneumonia
Neisseria
H. influenzae (Type B)
E. coli
Most common organisms for bacterial meningitis in patients 2-50 years
N. meningitidis
S. pneumoniae
H. influenzae incidence
Decreased since the Hip vaccine was made, but all gram-negative organisms are less common in general
All pregnant women engaged in prenatal care have to be tested for…
GBS; if positive, they get treated with ABX
Infant risk factors for bacterial meningitis
Basically, anything that has to do with the pregnancy/delivery process
Children risk factors for bacterial meningitis
Basically, anything that can impact the immune system
Presentation of bacterial meningitis in infants
poor feeding, vomiting, fever/temperature instabilities, seizures, irritability, lethargy, bulging fontanelle
Presentation of bacterial meningitis in children
fever, headache, lethargy, vomiting, myalgia, photophobia, stiff neck, seizure, confusion
Diagnosis of bacterial meningitis
Analysis of CSF from an LP- gold standard!
CSF analysis is NOT diagnostic of bacterial meningitis, it’s the positive culture that is
What to look for in CSF from LP
Elevated WBC and protein
Low glucose
Positive bacterial culture
CIs to LP
Increased intracranial pressure, coagulopathy, hemodynamic/respiratory instability, skin infection over LP site
Blood cultures in bacterial meningitis
2 separate cultures and a CBC w/diff should be obtained before starting ABX
Bacterial meningitis prevention
Hib vaccine, PCV13 vaccine, meningococcal conjugate vaccine
Empiric ABX regimen for kids <1 month with bacterial meningitis
Ampicillin + AG
Ampicillin + cefotaxime
Can add acyclovir if HSV suspected
Ampicillin covers what bacteria?
GBS, Listeria
Ampicillin ADEs
N/V/D, rash
Empiric ABX regimen for kids 1-23 months with bacterial meningitis
Vanco + cefotaxime OR ceftriaxone
Aminoglycosides cover what?
Gram-negatives
Cefotaxime and ceftriaxone cover what?
Gram-negatives
Which is preferred: ceftoxime or ceftriaxone and why?
CTX, because it’s only dosed BID (vs. q8h)
Who do you NOT use CTX in and why?
Neonates, because of hyperbilirubinemia
Empiric ABX therapy in patients 2-50 years with bacterial meningitis
Same as 1-23 months: Vanco + cefotaxime OR CTX
Vanco will cover for what?
Resistant strep species
Vanco AUC/MIC monitoring
> 400, but <600
Vanco trough concentrations
7-10mg/L; surrogate marker for efficacy, consider individual clinical response
ADEs of vanco
Nephrotoxicity, ototoxicity, infusion-related reactions
Monitor Sir and urine output
What is dexamethasone used for in bacterial meningitis?
Decrease hearing loss in infants and children >6 weeks infected with H. influenzae meningitis
When can dexamethasone be used?
Adjunctive therapy 10-20 minutes before or with the 1st dose of ABX
When is dexamethasone not beneficial?
When it’s given >1 hour after ABX
ISDA recommendations for dexamethasone: H. influenzae
recommended if initiated before ABX administration
ISDA recommendations for dexamethasone: S. pneumoniae
consider if there’s a high mortality risk
ISDA recommendations for dexamethasone: N. meningitidis/other gram-negatives
Not recommended
Overall, the use of dexamethasone is….
controversial
