Detection of Enterobacteriaceae in cerebrospinal fluid fluid of neonates with meningitis from tertiary care hospitals

OBJECTIVE

This study aimed to determine the bacteriological profile of childhood acute bacterial meningitis in Pakistan.

PATIENTS AND METHODS

The study included a total of 100 children aged between 1 month and 5 years, who were admitted with a diagnosis of meningitis based on clinical findings and positive cerebrospinal fluid (CSF) tests. Out of the 100 CSF samples collected, 21 isolates were confirmed to contain Enterobacteriaceae. The most prevalent Enterobacteriaceae species were Pseudomonas (n=8, 38.09%), Klebsiella (n=4, 19.04%), E. coli (n=4, 19.04%), and Acinetobacter (n=4, 19.04%), while Citrobacter (n=1, 4.76%) was less common. Antibiotic susceptibility patterns were analyzed for these isolates.

RESULTS

Pseudomonas (n=8) exhibited 25% resistance to cefepime and 38% resistance to imipenem. Klebsiella (n=4) showed 75% resistance to imipenem. Acinetobacter (n=4) demonstrated 50% resistance to imipenem, along with varying resistance to cefepime, amikacin, ciprofloxacin, and gentamicin. E. coli (n=4) showed 0% resistance to imipenem and amikacin. However, Citrobacter (n=1) showed 0% resistance to ciprofloxacin, aztreonam, gentamicin, amikacin, levofloxacin, and cefepime. Acute bacterial meningitis primarily affects children under 1 year of age.

CONCLUSIONS

CSF culture revealed that Gram-negative bacteria, specifically Pseudomonas spp., were the predominant pathogens in this family based on Pakistani data.

796 Post Operative Drop in Haemoglobin Is Associated with Increased Morbidity and Mortality in Fracture Neck of Femurs

Aim

Post-operative anaemia in hip fracture patients is associated with increased risk of blood transfusion, poorer outcomes, increased morbidity, and mortality. Our aim is measure the drop in haemoglobin(Hb) post-operatively in hip fracture surgery and its impact on length of stay, morbidity and 30-day mortality.

Method

A retrospective study of neck-of-femur patients looking at pre-op and discharge haemoglobin levels, taking into consideration conditions that could affect Hb, and adverse effects peri-operatively.Data collected from Medway, Clinic letters, ICE and NHFD database.

Results

257 patients were included in the study. Mean age was 82(range 43–100). Pre-operatively 60(23%) had normal Hb, 34(13%) had borderline, and 163(64%) had severe anaemia. 131(51%) had hemi-arthroplasty, 61(24%) had DHS, 45(18%) had IM nail and 20(7%) had THR.Normal Hb found in 62 patients (24%), 33(13%) had borderline and 162(63%) had severe anaemia at discharge.30 patients (11.7%) had post-op transfusions and 7 were prescribed oral iron. Readmission rate was 4.3%(11 patents) of which 8(73%) had severe anaemia.Average length of stay in patients with severe anaemia was 21 days.Overall 30-day mortality was 17%(43 patients); in patients with severe anaemia, mortality was 50%(21 patients).

Conclusions

Most patients (63%) had severe anaemia at discharge. There was a significant drop of Hb post-operatively especially THR and hemi-arthroplasty. Our study demonstrates pre-surgical anaemia in hip fracture patients is associated with increased hospital morbidity and mortality.Identification of anaemia at admission and discharge provides an opportunity for treatment to avoid transfusions and improve patient outcomes.