Clinical characteristics and pathogen distribution of bacterial meningitis in term neonates
Luo Xiaohong, Fu Yiyong, Xi Yufeng,et al
(Department ofNeonatology, Chengdu Women's and Children's Central Hospital, the Affiliated Women's and Children'sHospital, School of Medicine, University of Electronic Science and Technology of China, Sichuan, Chengdu 611731, China
Abstract: 【Abstract】 Objective To explore the clinical characteristics and pathogen distribution of bacterial meningitis in term neonates. Method In this study, we retrospectively analyzed the clinical data of 199 term neonatal cases of bacterial meningitis diagnosed in the Department of Neonatology, Chengdu Women'sand Children's Central Hospital from April 2017 to June 2020. According to the age of onset, the infants were divided into two groups: early-onset group (the age of onset ≤ 72 h, n=65) and late-onset group (the age of onset >72 h，n=134). The clinical manifestations, length of hospitalization, pathogen distribution and treatment outcome of the two groups were compared. t-test, χ2 test and rank sum test were used for statistical analysis. Result Among 199 cases of term neonates with bacterial meningitis, 29 cases (14.6%) were etiological proven. There were significant differences in complete blood count leukocyte count, neutrophil ratio, procalcitonin, cerebrospinal fluid protein, abnormal rate of amplitude integrated electroencephalography (aEEG) or electroencephalography (EEG) between the two groups (all P<0.05). Fever was the most common clinical presentation in 81.4% (162/199), and cases of fever in late-onset group were significantly higher than that in early-onset group [93.3% (125/134) vs 56.9% (37/65), χ2=38.231, P<0.05]. Also there were significant differences in the symptoms of tachypnea, poor appetite, vomiting and irritability between the two groups (all P<0.05). Among the 183 infants who completed cranial enhanced magnetic resonance imaging abnormalities were found in 145 cases (79.2%), including dura thickening, pia mater enhancement, widening of extra-cerebral space, intraventricular hematocele and ventricular enlargement, but there was no significant difference between the two groups (all P>0.05). Among 199 infants, 181 cases were cured (91.0%), 12 cases were improved (6.0%), and 6 cases were given up or died (3.0%). The cure rate in late-onset group was higher than that in early-onset group [94.8% (127/134) vs 83.1% (54/65)], the difference was statistically significant (χ2=7.228, P=0.027). The most common pathogens in early-onset group were Escherichia coli, Streptococcus agalactis, and Listeria monocytogenes. While the most common pathogens in late-onset group were Escherichia coli, Enterococcus faecium and Staphylococcus epidermidis. Conclusion Infants with bacterial meningitis often have fever, but the clinical manifestations are not specific. The most common gram-negative bacterium causing bacterial meningitis in term neonates is Escherichia coli. The most common earlyonset gram-positive bacteria are Streptococcus agalactis and Listeria monocytogenes, and the lateonset gram-positive bacteria are Enterococcus faecium and Staphylococcus epidermidis. In the course of treatment, antibiotics should be adjusted in time according to efficacy and drug sensitivity results.
罗晓红 傅益永 习玉峰 张小龙 朱玲 曾雯 巨容. 足月新生儿细菌性脑膜炎的临床特点及病原菌分布[J]. 发育医学电子杂志, 2022, 10(3): 196-202.
Luo Xiaohong, Fu Yiyong, Xi Yufeng, et al. Clinical characteristics and pathogen distribution of bacterial meningitis in term neonates. Journal of Developmental Medicine(Electronic Version), 2022, 10(3): 196-202.
2022, Vol. 10 
