Abstract Ref Number = APCP973
CHARACTERISTIC OF PRE-ANTIBIOTIC TREATMENT BACTERIAL MENINGITIS IN REFERRED HOSPITAL
Deisy Alexandria Taruli,Riyadi Riyadi,Anggraini Alam,Djatnika Setiabudi
Department of Infection and Tropical Medicine Hasan Sadikin General Hospital
Background : Meningitis is a central nervous system disease with high mortality and morbidity among children, with 18% of case caused by bacteria. Prompt and proper diagnoses is needed to provide appropriate treatment and achieving better outcome. The gold standard for diagnosis is lumber puncture examination, however not all hospitals are equipped to conduct the exam, and patients with clinical judgement of bacterial meningitis are treated with antibiotics. Tertiary hospitals often receive referred patients with suspected bacterial meningitis who had undergo antibiotic treatment. This may cause atypical lab results when aiming to confirm diagnosis by cytology and culture examination of cerebrospinal fluid (CSF). This study aims to describe cases of pediatric bacterial meningitis with pre-antibiotic treatment prior to referral.
Material : This is a cross sectional study. Data were obtained from patient medical records with discharge diagnosis bacterial meningitis (ICD X code G00.9) from January 2016 to December 2017. Records were analyzed for description of confirmed cases, which is defined as bacterial meningitis diagnosis by culture, gram stain or antigen detection in CSF or blood sample.
Results : A total of 23 medical records was collected. Sixteen (69.5%) male, seven (31,5%) female and most of them is between 1-12 months (65,2%). Most of them come with mild loss of consciousness (60%). Only 8 (34,7%) were confirmed cases by culture, with most of them (75%) came from non pre-antibiotic treatment group. 5 from 8 (62%) from non pre-antibiotic treatment group had cell counts ? 321, while from pre-antibiotic treatments group, 11 from 15 (73%) had cell counts < 321.
Conclusions : Postponing treatment in pediatric patients suspected with bacterial meningitis on clinical judgement is not suggested even though confirmed diagnosis using laboratory test is not available. Additional forms of diagnostic examinations not influenced by antibiotics are needed to confirm bacterial meningitis, such as Latex Agglutination Test (LAT) dan ferritin levels.
Keywords: bacterial meningitis lumbar puncture pre-antibiotic treatment