title: [Iatrogenic meningitis after diagnosis lumbar puncture: 3 cases reports in the paediatric Children's Hospital of Tunis].
abstract: We have collected cases of iatrogenic meningitis managed in the Children's Hospital of Tunis, between January 1998 and December 2006. Clinical information about each patient were collected, all bacterial samples were investigated in the microbiology laboratory of the hospital. Bacterial isolates were identified according to conventional criteria. In the interval under study, we recorded three cases of iatrogenic meningitis after lumbar puncture. Two cases occurred in newborn admitted for suspicion of neonatal infection and one in a 2-month-old infant admitted for exploration of hyperpyretic convulsion. In all patients, the initial cerebrospinal fluid was normal. All patients developed symptoms of acute meningitis within 72 hours after lumbar puncture; the second cerebrospinal fluid was, then, typical for purulent meningitis. The causal agents isolated in the three cases were Klebsiella pneumoniae, Enterobacter cloacae, and Serratia marcescens, all resistant to beta-lactams by extended spectrum beta-lactamase production. The use of quinolones was required in all cases. Different complications were recorded: hydrocephalus and brain abscess in one case, respiratory and hemodynamic failure managed in the intensive care unit in the second, and brain hygroma in the third case. This study shows high morbidity of iatrogenic meningitis. Simple aseptic precautions undertaken before the procedure of lumbar puncture can prevent such cases. The urgent need for increasing the awareness among medical personnel in hospitals of developing countries cannot be overemphasized.
authors.affiliation: Laboratoire de Microbiologie, Hôpital d'Enfants, Tunis-Bab Saadoun, Tunisia.
authors.forename: H
authors.initials: H
authors.lastname: Smaoui
authors.forename: D
authors.initials: D
authors.lastname: Hariga
authors.forename: N
authors.initials: N
authors.lastname: Hajji
authors.forename: A
authors.initials: A
authors.lastname: Bouziri
authors.forename: N
authors.initials: N
authors.lastname: Ben Jaballah
authors.forename: S
authors.initials: S
authors.lastname: Barsaoui
authors.forename: S
authors.initials: S
authors.lastname: Bousnina
authors.forename: A
authors.initials: A
authors.lastname: Sammoud
authors.forename: A
authors.initials: A
authors.lastname: Kechrid
mesh_terms: D001922:Brain Abscess / Q000209:etiology; D001925:Brain Damage, Chronic / Q000209:etiology; D002939:Ciprofloxacin / Q000627:therapeutic use; D004359:Drug Therapy, Combination; D016972:Enterobacter cloacae / Q000187:drug effects / Q000302:isolation & purification*; D004756:Enterobacteriaceae Infections / Q000188:drug therapy / Q000209:etiology*; D005260:Female; D005578:Fosfomycin / Q000627:therapeutic use; D006801:Humans; D006849:Hydrocephalus / Q000209:etiology; D007049:Iatrogenic Disease; D015378:Imipenem / Q000627:therapeutic use; D007223:Infant; D007231:Infant, Newborn; D007234:Infant, Premature; D007235:Infant, Premature, Diseases / Q000175:diagnosis / Q000188:drug therapy / Q000209:etiology*; D007710:Klebsiella Infections / Q000188:drug therapy / Q000209:etiology*; D007711:Klebsiella pneumoniae / Q000187:drug effects / Q000302:isolation & purification*; D008297:Male; D016920:Meningitis, Bacterial / Q000188:drug therapy / Q000209:etiology* / Q000382:microbiology; D009123:Muscle Hypotonia / Q000175:diagnosis; D012640:Seizures / Q000175:diagnosis; D016868:Serratia Infections / Q000188:drug therapy / Q000209:etiology*; D012706:Serratia marcescens / Q000187:drug effects / Q000302:isolation & purification*; D013129:Spinal Puncture / Q000009:adverse effects*; D013353:Subdural Effusion / Q000209:etiology; D014416:Tunisia; D018440:beta-Lactam Resistance
chemical_list: D005578:Fosfomycin; D002939:Ciprofloxacin; D015378:Imipenem