INFLUENCE OF ANTIBIOTIC THERAPY PRIOR TO ADMISSION ON THE EFFICACY OF CLASSICAL METHODS FOR THE DIAGNOSIS OF MENINGOCOCCAL DISEASE

Authors

  • Roxana Elena NEMESCU University of Medicine and Pharmacy”Grigore T. Popa” – Iași
  • Luminita Smaranda IANCU University of Medicine and Pharmacy”Grigore T. Popa” – Iași
  • Olivia Simona DORNEANU University of Medicine and Pharmacy”Grigore T. Popa” – Iași
  • Ramona Gabriela URSU University of Medicine and Pharmacy”Grigore T. Popa” – Iași
  • Carmen Mihaela DOROBAT University of Medicine and Pharmacy”Grigore T. Popa” – Iași

Keywords:

MENINGOCOCCAL DISEASE, PREADMISSION ANTIBIOTIC THERAPY, DIRECT CSF EXAMINATION, CSF CULTURE, BLOOD CULTURE

Abstract

Aim: To assess the influence of preadmission antibiotic therapy on the results of the classical methods for bacteriological confirmation of meningococcal disease (MD). Material and methods: Retrospective study of the MD cases diagnosed in the “St. Parascheva” Universitary Clinical Infectious Diseases Iaşi between 1994 and 2011. Results: The etiological diagnosis was made by identifying the meningococcus in the CSF (cerebrospinal fluid) in 71.9% of the 323 patients and by blood culture in 8%. Preadmission antibiotic therapy received 39% of the patients, thus the sensitivity of test was significantly reduced: direct examination from 64.6% to 43.2% (p < 0.001), cultures from 55.9% to 27.2% (p<0.001), and latex-agglutination from 84.6% to 58.8% (p=0.003). The rate of positive CSF decreased from 82.1% to 56% (p<0.001). Preadmission antibiotic therapy significantly increased the ratio of cases in which meningococcus was not detected in CSF by any of the classical methods (44% compared to 17.9% in the cases without prior treatment). The proportion of cases in which meningococcal isolation was done by two methods decreased from 38.5% to 19.2%, and of those by all three methods from 16.9% to 5.6% (p<0.001). Preadmission antibiotic therapy also decreased the rate of positive blood cultures from 14.7% to 3.5% (Fisher’s exact test, p=0.009). Conclusions: Antibiotic treatment prior to admission significantly decreases the percentage of patients with MD in which meningococcal isolation can be done; this requires the use of a more sensitive diagnosis method (ex. qPCR).

Author Biographies

  • Roxana Elena NEMESCU, University of Medicine and Pharmacy”Grigore T. Popa” – Iași

    Faculty of Medicine                                                                                                                                                                Ph.D. student
    Discipline of Infectious Diseases

  • Luminita Smaranda IANCU, University of Medicine and Pharmacy”Grigore T. Popa” – Iași

    Faculty of Medicine

    Discipline of Microbiology

  • Olivia Simona DORNEANU, University of Medicine and Pharmacy”Grigore T. Popa” – Iași

    Faculty of Medicine

    Discipline of Microbiology

  • Ramona Gabriela URSU, University of Medicine and Pharmacy”Grigore T. Popa” – Iași

    Faculty of Medicine

    Discipline of Microbiology

  • Carmen Mihaela DOROBAT, University of Medicine and Pharmacy”Grigore T. Popa” – Iași

    Faculty of Medicine                                                                                                                                                        Discipline of Infectious Diseases

     

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Additional Files

Published

2018-05-09

Issue

Vol. 118 No. 2 (2014): The Medical-Surgical Journal

Section

PREVENTIVE MEDICINE - LABORATORY

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