Clinical Characteristics And Related Refractory Factors Of Childhood Bacterial Meningitis With Positive Etiology

Objective:To summarize the clinical features and analyze the related refractory factors of bacterial meningitis(BM)with positive etiology in children.Methods:Retrospectively analyze the clinical data of 109 BM with positive etiology,from January 2014 to September 2018,admitted to Children’s Hospital of Chongqing Medical University,and summarize their clinical characteristics.According to the refractory BM standards,109cases would be divided into two groups,named as refractory group and non-refractory group.The incidence rate of childhood refractory BM could be achieved;statistical methods were used to determine the risk factors of childhood refractory bacterial meningitis with positive etiology.Results:(1)The peak age of childhood BM of these cases with positive etiology is<1 yr(63.3%).Fever(94.5%),fatigue(85.3%),vomiting(61.5%),positive meningeal irritation(52.3%),positive Babinski sign(45.9%)are the common clinical manifestation.At the early clinical course,the peripheral blood examination showed abnormal WBC(58.7%),abnormal PLT(61.5%),moderate-severe anemia(22.9%),high CRP and PCT;And accompanied significant changes in cerebrospinal fluid,the proportion of these cases of CSF-WBC≥500*10~6/L,CSF-protein>1.0g/L and CSF-glucose<1.50 mmol/L were 42.1%,73.8%and 38.3%,respectively.(2)The positive rate of blood culture(78.9%)is higher than CSF culture(43.2%).S.pneumoniae(35.7%)is the most common pathogens in these subjects,followed by Escherichia coli(22.9%).The results of drug sensitive test indicated that the resistance rate of S.pneumoniae to penicillin was 50.0%,and no strain of S.pneumoniae resistant to vancomycin was found;the resistance rate of cefotaxime to Escherichia coli was 56.0%,and no strain of Escherichia coli resistant to carbapenems was found.The distribution of pathogen has certain correlation with age.Escherichia coli(47.5%)is the main pathogen of children aged 1~3 months,followed by Group b streptococci(10.0%);S.pneumoniae(55.1%)is the most commonest pathogen of children aged more than 3 months,followed by Escherichia coli(8.7%).(3)109 cases were classified according to the refractory group criteria.There were 96cases in the refractory group and 13 cases in the non-refractory group.The refractory rate was 88.1%.The result of univariate analysis:disturbance of consciousness,slow or insensitive pupillary light reflex,CRP≥50mg/L,PCT>30 ng/dl,CSF-WBC≥500*10~6/L,CSF protein≥1.0 g/L,CSF glucose<1.5 mmol/L,Gram-positive bacteria,the 8 factors related to the refractory BM.Multiple logistic analysis:disturbance of consciousness,CRP≥50mg/L,Gram-positive bacteria are the independent risk factors for predicting who would progress to refractory BM with pathogenic positive meningitis in this group.Conclusion:Pathogen-positive BM in these cases has typical clinical symptoms,Most of these case’s peripheral blood inflammation indicators increased,and their cerebrospinal fluid showed purulent changes.The common pathogens are S.pneumoniae and Escherichia coli.Most of BM with positive etiology in childhood would progress to refractory BM,which may be related to disturbance of consciousness or significantly increased peripheral blood CRP(≥50mg/L)or Gram-positive bacteria in the early clinical course.