Clinical Predictors, Antibiogram, and the Relationship Between Abnormal Leucocytes and Positive Cerebrospinal Bacterial Isolates in Children seen at a Tertiary Facility in Nigeria.

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Abstract

Abstract Background: Acute bacterial meningitis (ABM) remains a significant public health concern in resource-limited settings like Nigeria. It is a frequent neurologic emergency among children and often presents at under-resourced medical centers. This study aimed to identify the clinical predictors of ABM, evaluate the antibiogram of bacterial isolates, and assess the relationship, if any, between subjects’ white blood cell counts and positive cerebrospinal fluid (CSF) cultures in children suspected of ABM. Methods: This prospective study involved 100 post-neonatal children presenting with suspected ABM at the Children’s Emergency Room of Federal Medical Centre, Umuahia, from January 2016 to December 2020. Data were collected through a structured proforma, capturing clinical features, CSF analysis, and hematologic findings. The data were analyzed using SPSS version 23, employing descriptive statistics, regression analysis, Wald testing, and ROC analysis. Results: Fever, altered consciousness, neck stiffness, convulsion, vomiting, high-pitched cry and bulging anterior fontanelle, were significant predictors of ABM. Antibiotic susceptibility testing revealed that aminoglycocides, fluoroquinolones, macrolides, amoxicillin, cephalosporins, and carbapenems were effective against common bacterial isolates in 68%, 37%, 35%, 37%, and 23% of cases, respectively. No significant relationship was observed between abnormal leucocyte counts and positive bacterial CSF cultures. Conclusion Fever, altered consciousness, neck stiffness, convulsion, vomiting, high-pitched cry and bulging fontanelle were reliable clinical indicators of ABM. Fluoroquinolones and aminoglycosides demonstrated the highest sensitivity in the antibiogram. The weak association between abnormal leucocyte counts and positive CSF cultures, highlights the importance of early empirical treatment, particularly when lumbar puncture is delayed.