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Title: The causes, presentation, outcome and management of bacterial meningitis in young infants
Author: Okike, Ifeanyichukwu O
ISNI:       0000 0004 7427 1356
Awarding Body: St George's, University of London
Current Institution: St George's, University of London
Date of Award: 2017
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Background and objectives Bacterial meningitis (BM) is associated with significant morbidity and mortality The case fatality rates amongst neonates have declined but rates of sequelae have remained unchanged. This thesis aimed to define the current burden, management and outcome in young infants. Methods Two national surveillance studies conducted using national reporting systems by the Public Health England and neonatal unit infection network, in combination with prospective/ retrospective multi-centre observational studies were used. Results The incidence of BM is highest in infants <90 days compared to any other age group. In neonates, the incidence and aetiology has not changed since the 1980s. Group B streptococcus and E. coli remain the leading causes; neither are currently vaccine- preventable. Listeria meningitis occurred only in the first month of life with implications for national empiric antibiotic recommendations. The presenting features are non-specific and only half presented with fever, which could potentially lead to significant delays in initiating empiric antibiotics. In a subset of 97 infants, the time from triage to receipt of first antibiotic dose was 2.0 hours (IQR: 1.0-3.3) hours, significantly shorter in infants with fever or seizures at presentation compared to those without. Almost all symptoms reported by parents appeared at the onset of the illness, with very few new symptoms appearing subsequently. We have identified gaps in the current management of cases. 4 Dr. Ifeanyichukwu Ogbonnaya Okike 2017 8% died, and 20% of survivors suffered a serious central nervous system (CNS) complication at discharge. The independent risk factors for death were prematurity, low birthweight, coma at presentation and pneumococcal meningitis, whilst temperature instability, seizures, CSF protein >2275 mg/dl and pneumococcal meningitis were independently associated with serious CNS complications. Conclusion The incidence of BM in young infants and rates of serious CNS complications have not changed in more than three decades. Our e-leaming tool based on lessons from the course of illness and clinical management of cases in addition to our proposed management algorithm will be invaluable resources. An effective GBS vaccine is needed to reduce the burden of serious bacterial infection in young infants.
Supervisor: Not available Sponsor: Not available
Qualification Name: Thesis (Ph.D.) Qualification Level: Doctoral
EThOS ID:  DOI: Not available