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Vol. 56. Núm. 6.
Páginas 556-563 (junio 2002)
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Vol. 56. Núm. 6.
Páginas 556-563 (junio 2002)
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Meningitis neonatal. Estudio epidemiológico del Grupo de Hospitales Castrillo
Neonatal meningitis. epidemiological study of the grupo de hospitales castrillo
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11202
Grupo de Hospitales Castrillo , G.D. Coto Cotallo, J.B. López Sastre
Autor para correspondencia
jlopezs@hcas.insalud.es

Correspondencia: Servicio de Neonatología. Hospital Central de Asturias. Celestino Villamil, s/n. 33006 Oviedo
, B. Fernández Colomer, J.Ma. Fraga Bermúdez, J.R. Fernández Lorenzo, R. Reparaz Vidal, I. Fidalgo Álvarez, E. Álvaro Iglesias, M.aP. Aragón García, C. González Armengod, M.aC. Pedraz García, A. Urbón Artero, P. Aparicio Lozano, A. Cotero Lavín, L. Paisán Grisolía, A. Marco Tello, J. Pérez González, A. Belaustegui Cueto, E. Gómez Castillo..., M. Moro Serrano, M. Sánchez Luna, S. Salas Hernández, S. Salcedo Abizanda, X. Carbonell Estrany, J. Figueras Aloy, X. Krauel i Vidal, M. Iriondo Sanz, R. Baraibar Castelló, V. Roqués Serradilla, J. Ortiz Tardío, M. García del Río, M. Samaniego Muñoz, E. Narbona López, E. Doménech MartínezVer más
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Información del artículo
Objetivos

Analizar la incidencia, etiología, factores riesgo y evolu-ción de las meningitis neonatales de transmisión vertical y nosocomial durante un período de 2 años

Pacientes y método

Se estudiaron de manera prospectiva las meningitis neonatales diagnosticadas en 28 hospitales integrados en el Grupo de Hospitales Castrillo desde el 1 de enero de 1997 hasta el 31 de diciembre de 1998. Se consideró meningitis microbiológicamente probada cuando el cultivo de líquido cefalorraquídeo (LCR) fue positivo para bacterias, virus u hongos; meningitis probable cuando el cultivo de LCR fue negativo y el hemocultivo positivo y meningitis no probada cuando ambos cultivos fueron negativos

Resultados

Durante el período de estudio se recogieron 151 meningitis, de las cuales 84 fueron de transmisión vertical y 67 de transmisión nosocomial.

La meningitis vertical tuvo una incidencia de 0,51 %o recién nacidos vivos, siendo más frecuente en los recién nacidos de muy bajo peso. En 66 casos (78,6%) se diagnosticó meningitis microbiológicamente probada. En el 46,4% de los casos no se objetivó ningún factor riesgo. Streptococcus agalactiae betahemolítico del grupo B (EGB) fue responsable del 48,5% de las meningitis probadas y Escherichia coli del 18,2%. En el 69,7% de los casos se comprobó hemocultivo positivo coincidente. La mortalidad global fue del 8,3 %, siendo superior en los menores de 1.500 g (33,3% frente a 4,2% en niños > 1.500 g). Presentaron secuelas el 13 % de los supervivientes.

La incidencia de meningitis nosocomial fue de 0,20 % ingresos, siendo también más frecuente en los recién nacidos de muy bajo peso. Se diagnosticó meningitis probada en 49 casos (73,1 %). El 62,7% de los casos presentaron dos o más factores de riesgo. E. coli fue responsable del 26,5% y S. epidermidis del 24,5%. Se comprobó hemocultivo positivo coincidente en el 55 % de los casos. La mortalidad fue del 19,4%, siendo superior en los de peso inferior a 1.500 g. Se objetivaron secuelas en el 18,5% de los supervivientes.

Conclusiones

La incidencia, mortalidad y secuelas de la meningitis neonatal en nuestro país fueron similares a las comunicadas en trabajos significativos recientes. Los microorganismos aislados más frecuentemente fueron EGB en las meningitis verticales y E. coli y S. epidermidis en las nosocomiales. La distinta, lo que implica una actitud terapéutica diferente. El elevado porcentaje de hemocultivo positivo coincidente aboga por la realización de punción lumbar siempre que se sospeche infección sistémica en el período neonatal

Palabras clave:
Neonato
Meningitis
Transmisión vertical
Transmisión nosocomial
Sepsis neonatal
Punción lumbar
Streptococcus agalactiae
Objectives

A prospective multicenter study was designed to assess the incidence, etiology, risk factors and outcomes of vertically transmitted and nosocomial meningitis in neonates over a two-year period.

Patients and methods

Cases of neonatal meningitis diagnosed between January 1, 1997 and December 31, 1998 in the neonatology departments of 28 acutecare hospitals in Spain ("Grupo de Hospitales Castrillo") were prospectively studied. Bacteriological meningitis was considered confirmed when cerebrospinal fluid culture (CSF) was positive for bacteria, virus or fungi, probable when CSF culture was negative but blood culture was positive, and unconfirmed when both cultures were negative

Results

During the study period, 151 cases of meningitis were diagnosed. Transmission was vertical in 84 cases and nosocomial in 67. The incidence of vertically transmitted meningitis was 0.51 %o of live births, and was significantly higher in very low birth weight (VLBW) infants. Confirmed bacteriological meningitis was diagnosed in 66 patients (78.6%). No risk factors were identified in 46.4% of the patients. Group B Streptococcus (agalactiae) was isolated in 48.5% of cases of confirmed meningitis and Escherichia coli was isolated in 18.2 %. In 69.7 % of cases the results of blood culture were in agreement with those of CSF culture. The overall mortality rate was 8.3 %; mortality was significantly higher in VLBW infants (33.3 % vs 4.2% in infants weighing > 1,500 g). Thirteen percent of survivors had sequelae.

The incidence of meningitis of nosocomial transmission was 0.2 % of admissions and was more frequent in VLBW infants. Confirmed bacteriological meningitis was diagnosed in 49 patients (73.1 %). Two or more risk factors were present in 62.7% of patients. E. coli was isolated in 26.5% of cases of nosocomial meningitis and Staphylococcus epidermidis was isolated in 24.5%. In 55% of patients the results of blood culture agreed with those of CSF culture. The overall mortality rate was 19.4%. Mortality was significantly higher in VLBW infants and 18.5 % of survivors showed sequelae.

Conclusions

The incidence, mortality and sequelae of neonatal meningitis in Spain were similar to those reported in recent studies. The most commonly isolated pathogens were group B Streptococcus in vertically transmitted meningitis and E. coli and S. epidermidis in nosocomial meningitis. We believe the distinction between vertical and nosocomial meningitis to be appropriate because the epidemiology of these diseases is different, which implies a different therapeutic approach. The high percentage of positive blood cultures indicates the need to include lumbar puncture whenever systemic infection is suspected in the neonatal period.

Key words:
Newborn Meningitis
Vertical transmission
Nosocomial transmission
Neonatal sepsis
Lumbar puncture
Streptococcus agalactiae
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