| BackgroundThe development of neonatal nervous system and immune system is not perfect,and the function of blood brain barrier is poor,When bacterial infection and pyemia(septicemia)and other infections,it is easy to cause neonatal bacterial meningitis.Neonatal bacterial meningitis is a common nervous system infection in newborns,because its clinical manifestations are not typical,early diagnosis and treatment are difficult,if not timely treated,seriously can result in death,survivors can cause a series of neurological sequelae in childhood,such as epilepsy,blindness,hearing loss,cerebral palsy,mental retardation,autism and so on.The bacterial epidemic spectrum of neonatal bacterial meningitis in different regions and even in the same area may be different.By understanding the epidemiological characteristics of bacterial in a certain area,it is helpful to guide clinical experiential medication and to avoid death or disability caused by improper treatment or improper use of drugs.The previous literature on neonatal bacterial meningitis is mostly a single center case analysis,and the clinical guidance is limited.Therefore,this study is going to analyze the epidemiological characteristics of neonatal bacterial meningitis in Guangdong and Guangxi through a multicenter,large sample retrospective study,so as to provide evidence for clinical experience in the treatment of neonatal bacterial meningitis.Abstract ObjectiveTo discuss the epidemiological characteristics(clinical features,pathogenic bacteria distribution,treatment,complication and outcome)of neonatal bacterial meningitis in some areas of Guangdong Province and Guangxi Municipality.MethodsA retrospective epidemiological study was carried out in the infants with bacterial meningitis admitted to 12 hospitals which are located in Guangdong Province and Guangxi Municipality between Jan.2011 and Dec.2016.Distribution of pathogenic bacterialandepidemiologicalcharacteristicswereanalyzedduringdifferent periods(2011-2012?2013-2014?2015-2016)and different types(early-onset/late-onset and preterm infants/term infants)of positive cases.And also analysis the clinical features,treatment,complication,outcome of neonatal bacterial meningitis.Result1.A total of 838 cases which met the criteria of neonatal bacterial meningitis were admitted during the study period.Male 545 cases,female 293 cases,age of onset 8(2,16)days,age at diagnosis 14(8,20)days.Culture findings were positive in 249 infants(29.7%),according to the positive rate of culture Streptococcus agalactiae(GBS),Escherichia coli,Coagulase negative staphylococcus,Klebsiella pneumoniae,etc.2.The positive rate was 29.6%(47/159),33.6%(85/253)and 27.5%(117/426)respectively in the 2011-2012,2013-2014,2015-2016,there was no significant difference among the three periods(?~2=2.86,P=0.239).In the culture positive cases,there was no significant difference between the gram-negative bacilli and gram-positive cocci proportion in the three different periods(?2=2.081,P=0.353).3.The positive rates of cerebrospinal fluid(CSF)culture and blood culture were33.0%(64/194)and 28.7%(185/644)in early-onset and late-onset bacterial meningitis infants.The differences of gram-negative bacilli and gram-positive cocci proportion in the two groups were significant(15/49 vs 83/103,?2=8.967,P=0.003),the most common bacteria was gram-positive cocci-GBS.4.The positive rates of cerebrospinal fluid(CSF)culture and blood culture were26.9%(57/212)and 30.7%(192/626)in preterm infants and term infants,there was no significant difference between the two groups(?2=1.086,P=0.297).The differences of gram-negative bacilli and gram-positive cocci proportion in the two groups were significant(40/18 vs 58/134,?~2=28.074,P=0.000);the bacteria of preterm infants was mainly gram-negative bacilli,the most common one was Escherichia coli;while that of term infants was mainly gram-positive cocci,the most common one was GBS.5.There were 45 cases(5.4%)of which cerebrospinal fluid(CSF)WBC counts were less than 20×10~6/L when they were confirmed,among them 5 cases of CSF culture were positive;there were 728 cases(91.7%)of CSF WBC less than 20×10~6/L at discharge.The positive rate of blood culture and CSF culture declined 8.2%and 5.3%respectively in case of the antibiotics used more than 24 hours and less than 24 hours,which was significantly different(?2=19.668,P=0.000).6.Fever was the common manifestation(633cases,75.5%),there was a significant difference in the incidence of fever between the early-onset and late-onset bacterial meningitis(213 vs 420,?2=100.889,P=0.000),there also were significant differences in the incidence of fever and convulsions between the preterm and full term bacterial meningitis(101 vs 519,?2=105.211,P=0.000;24 vs 117,?2=6.380,P=0.012).7.The median number of antibiotic used days before diagnosed group was 3d while the median number of antibiotic treatment used days after diagnosed group was 22d.225cases used single drug(30.5%),583 cases used combination drugs.The single drug used mainly were Meropenem(146 cases,57.3%)and tertiary-generation cephalosporin(67cases,26.3%);combination drugs used mainly were Meropenem+tertiary-generation cephalosporin(302 cases,51.8%)and Penicillin(or vancomycin)+tertiary-generation cephalosporin(115 cases,19.7%).There was no significant difference between single drug and combination therapy groups about treatment and efficacy in cases of culture positive.8.Hydrocephalus was the most common complication(167 cases,20.0%),gram-negative bacillus was more common than gram-positive cocci.Fever,convulsions,cerebrospinal fluid leucocyte over 100×10~6/L,cerebrospinal fluid glucose under1.1mmol/L,cerebrospinal fluid protein over 1.5g/L,peripheral blood leukocyte under5×10~9/L or over 20×10~9/L,CRP over 8mg/L,the positive of blood culture and cerebrospinal fluid culture were independent dangerous factors that influenced the incidence of complications(all P<0.05).9.There were 801 infants(801/838,95.6%)who were cured or improved at discharge but 13 deaths(13/838,1.6%).Conclusion1.The most common bacterias of neonatal bacterial meningitis were GBS and Escherichia coli in some areas of Guangdong Province and Guangxi Municipality,the most common bacteria was GBS in the early-onset and late-onset bacterial meningitis,but in preterm infants the most common bacteria was Escherichia coli,while that of term infants group was GBS.2.Fever was the common clinical manifestations,and the incidence of fever was less in the early-onset bacterial meningitis,and the incidence of fever and convulsions were less in the preterm bacterial meningitis.3.The positive rate of cerebrospinal fluid(CSF)culture and blood culture was29.7%,and the positive rates of cerebrospinal fluid(CSF)culture and blood culture were33.0%and 28.7%respectively in early-onset and late-onset bacterial meningitis infants.The positive rate of blood culture and CSF culture declined 8.2%and 5.3%respectively in case of the antibiotics used more than 24 hours.4.The clinical treatment of neonatal bacterial meningitis was still dominated by drug combination,the three generation of cephalosporin and meropenem were commonly used antibiotics.5.Hydrocephalus was the most complications.Fever,convulsions,cerebrospinal fluidleucocyteover100×10~6/L,cerebrospinalfluidglucoseunder1.1mmol/L,cerebrospinal fluid protein over 1.5g/L,peripheral blood leukocyte under5×10~9/L or over 20×10~9/L,CRP over 8mg/L,the positive of blood culture and cerebrospinal fluid culture were independent dangerous factors that influenced the incidence of complications. |
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