Lumbar Puncture and Meningitis in Infants with Proven Early- or Late-Onset Sepsis: An Italian Prospective Multicenter Observational Study-Reference-Cited by-同舟云学术

Lumbar Puncture and Meningitis in Infants with Proven Early- or Late-Onset Sepsis: An Italian Prospective Multicenter Observational Study

Published:2023-06-10 Issue:6 Volume:11 Page:1546
ISSN:2076-2607
Container-title:Microorganisms
language:en
Short-container-title:Microorganisms

Author:

Bedetti Luca¹²,Miselli Francesca¹²^ORCID,Minotti Chiara¹^ORCID,Latorre Giuseppe³^ORCID,Loprieno Sabrina⁴,Foglianese Alessandra⁴,Laforgia Nicola⁴^ORCID,Perrone Barbara⁵,Ciccia Matilde⁶,Capretti Maria Grazia⁷,Giugno Chiara⁸,Rizzo Vittoria⁹,Merazzi Daniele¹⁰,Fanaro Silvia¹¹,Taurino Lucia¹²,Pulvirenti Rita Maria¹³,Orlandini Silvia¹⁴,Auriti Cinzia¹⁵,Haass Cristina¹⁶,Ligi Laura¹⁷,Vellani Giulia¹⁸,Tzialla Chryssoula¹⁹,Tuoni Cristina²⁰,Santori Daniele²¹,China Mariachiara²²,Baroni Lorenza²³,Nider Silvia²⁴,Visintini Federica²⁵,Decembrino Lidia²⁶,Nicolini Giangiacomo²⁷^ORCID,Creti Roberta²⁸^ORCID,Pellacani Elena²⁹,Dondi Arianna³⁰^ORCID,Lanari Marcello³⁰,Benenati Belinda³¹,Biasucci Giacomo³¹^ORCID,Gambini Lucia³²,Lugli Licia¹,Berardi Alberto¹^ORCID

Affiliation:

1. Neonatal Intensive Care Unit, University Hospital of Modena, 41224 Modena, Italy

2. PhD Program in Clinical and Experimental Medicine, University of Modena and Reggio Emilia, 21124 Modena, Italy

3. Neonatal Intensive Care Unit, Ecclesiastical General Hospital F. Miulli, 70021 Acquaviva delle Fonti, Italy

4. Department of Biomedical Science and Human Oncology (DIMO), Neonatal Intensive Care Unit, University Hospital of Bari “Aldo Moro”, 70124 Bari, Italy

5. Neonatal Intensive Care Unit, Azienda Ospedaliero Universitaria delle Marche, 60126 Ancona, Italy

6. Neonatal Intensive Care Unit, Women’s and Children’s Health Department, Maggiore Hospital, 40133 Bologna, Italy

7. Neonatal Intensive Care Unit, Women’s and Children’s Health Department, S. Orsola-Malpighi Hospital, 40138 Bologna, Italy

8. Pediatric Unit, Ospedale B. Ramazzini, 41012 Carpi, Italy

9. Neonatal Intensive Care Unit, Bufalini Hospital, 47521 Cesena, Italy

10. Division of Neonatology, “Valduce” Hospital, 22100 Como, Italy

11. Department of Medical Sciences, Pediatric Section, University Hospital, 44124 Ferrara, Italy

12. Neonatal Intensive Care Unit, Ospedali Riuniti, 71122 Foggia, Italy

13. Pediatric and Neonatal Unit, Morgagni-Pierantoni Hospital of Forlì, 47121 Forli, Italy

14. Neonatal Intensive Care Unit, Carlo Poma Hospital, 46100 Mantova, Italy

15. Neonatal Intensive Care Unit, Medical and Surgical Department of Fetus-Newborn-Infant, “Bambino Gesù” Children’s Hospital IRCCS, 00165 Rome, Italy

16. Neonatal Intensive Unit, San Pietro-Fatebenefratelli Hospital, 00168 Rome, Italy

17. Neonatal Intensive Unit, San Filippo Neri Hospital, 00135 Rome, Italy

18. Neonatal Intensive Unit, ARNAS Civico-Di Cristina-Benfratelli, 90127 Palermo, Italy

19. Neonatal and Pediatric Unit, Polo Ospedaliero Oltrepò, ASST Pavia, 27100 Pavia, Italy

20. Neonatology and Neonatal Intensive Care Unit, Department of Clinical and Experimental Medicine, University Hospital of Pisa, 56124 Pisa, Italy

21. Pediatric and Neonatal Unit, Azienda Ospedaliera Santa Maria degli Angeli, 33170 Pordenone, Italy

22. Neonatal Intensive Care Unit, Infermi Hospital, 47923 Rimini, Italy

23. Neonatal Intensive Care Unit, Santa Maria Nuova Hospital, 42123 Reggio Emilia, Italy

24. Neonatal Intensive Care Unit, Institute for Maternal and Child Health, IRCCS Burlo Garofolo, 34137 Trieste, Italy

25. Neonatology Unit, University Hospital of Udine, 33100 Udine, Italy

26. ASST Pavia, Unità Operativa di Pediatria e Nido, Ospedale Civile, 27029 Vigevano, Italy

27. Pediatric Unit, San Martino Hospital, 32100 Belluno, Italy

28. Department of Infectious Diseases, Istituto Superiore di Sanità, 00161 Rome, Italy

29. Residency in Pediatrics, Departmento of Medical and Surgical Science, University of Modena and Reggio Emilia, 41124 Modena, Italy

30. Pediatric Emergency Unit, IRCCS Azienda Ospedaliero Universitaria di Bologna, 40138 Bologna, Italy

31. Pediatric and Neonatal Unit, Women’s and Children’s Health Department, Guglielmo da Saliceto Hospital, 29121 Piacenza, Italy

32. Neonatal Intensive Care Unit, University Hospital of Parma, 43126 Parma, Italy

Abstract

Background: To evaluate the rates of lumbar puncture (LP) in infants with culture-proven sepsis. Study design: We prospectively enrolled 400 infants with early- or late-onset sepsis due to Group B streptococcus (GBS) or Eschericha coli, diagnosed within 90 days of life. Rates of LP and potential variables associated with LP performance were evaluated. Moreover, cerebrospinal fluid (CSF) characteristics and results of the molecular analysis were investigated. Results: LP was performed in 228/400 (57.0%) infants; 123/228 LPs (53.9%) were performed after antibiotic initiation, hampering the ability to identify the pathogen in the CSF culture. However, polymerase chain reaction increased the probability of positive results of CSF analysis compared to microbiological culture (28/79, 35.4% vs. 14/79, 17.7%, p = 0.001). Severe clinical presentation and GBS infection were associated with higher LP rates. The rate of meningitis was 28.5% (65/228). Conclusions: Rates of LP are low in culture-proven neonatal sepsis and antibiotics are frequently given before LP is carried out. Thus meningitis may be underestimated, and the chances of giving an effective therapy to the newborn are reduced. LP should be performed before the start of antibiotics when there is a clinical suspicion of infection.

Funder

European Union

Regione Emilia-Romagna

Publisher

MDPI AG

Subject

Virology,Microbiology (medical),Microbiology

Link

https://www.mdpi.com/2076-2607/11/6/1546/pdf

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