A 4-year study of neonatal meningitis: clinical and microbiological findings.

The clinical and microbiological data of 60 neonates, 23 from the Neonatal Unit (Group I) and 37 (Group II) from the General Paediatric Wards with meningitis are presented. The overall prevalence/1000 was significantly lower in Group I (0.36) than in Group II (1.11; P < 0.0001). This low incidence follows the introduction of amikacin for the treatment of the ill neonate in 1986. Streptococcus agalactiae 21 (35 per cent), Klebsiella pneumoniae 17 (28 per cent) and E. coli 10 (17 per cent) were the commonest pathogens accounting for 80 per cent of the cases. Streptococcus agalactiae isolates were uniformly susceptible to penicillin and chloramphenicol. Gram negative isolates showed resistance to ampicillin, chloramphenicol and sulphamethoxazole-trimethoprim. In addition K. pneumoniae isolates showed resistance to gentamycin and amikacin. All isolates were fully susceptible to cefotaxime. Recently, four of six cases of K. pneumoniae in the Neonatal Unit were resistant to amikacin. Low birth weight, additional clinical problems, and ultrasound changes on cranial scanning carried a poor prognosis. Emphasis should be placed on close collaboration between clinicians and microbiologists in the choice of antimicrobial agents and aseptic techniques for the care of neonates.