Abstract：Objective To study the clinical characteristics,pathogen distribution,treatment and outcome of purulent meningitis in neonates in order to provide the guide for early diagnosis and appropriate treatment.Methods The case data of 134 newborn children with purulent meningitis who were admitted to Fujian Maternity and Child Health Hospital from January 1,2014 to December 31,2016 were retrospectively analyzed.According to the results of blood culture or cerebrospinal fluid (CSF) culture,the subjects were divided into the Streptococcus agalactiae (GBS) group (15 cases),the other bacteria group (14 cases),and the unknown pathogen group (105 caces),and the clinical characteristics of each group were compared.Results The main clinical manifestations of purulent meningitis were fever,shortness of breath and jaundice,fever was the most common symptom.The positive rate of blood and cerebrospinal fluid culture was low,mainly GBS and Escherichia coli.C-reactive protein (CRP) levels in the GBS group and the other bacteria group were higher than those in the unknown pathogen group,and the differences were statistically significant (P＜0.05).The cerebrospinal fluid white blood cell counts of the other bacteria group and the GBS group were higher than those of the unknown pathogen group,the percentage of CSF polykaryotic cells in the GBS group was higher than that in the other bacteria group and the unknown pathogen group,and the differences were statistically significant (P＜0.05).There were 30 cases with CSF protein exceeding 1.88 g/L,among whom 13 cases had complications.A total of 83 cases were cured,44 cases were improved,2 cases were complicated with subdural effusion for further treatment by neurosurgery,and 5 cases were abandoned due to severe complications.Conclusion The clinical manifestations of neonatal purulent meningitis are lack of specificity,fever is the most common symptom.The main pathogens are GBS and Escherichia coli,and GBS infection should be considered if CRP,the percentage of leukocytes and polynuclear cells in CSF increase significantly.
陈志卿;周丹;林芳芳. 不同病原菌化脓性脑膜炎患儿的临床特点对比分析[J]. 中国当代医药, 2020, 27(30): 13-17.
CHEN Zhi-qing; ZHOU Dan ;LIN Fang-fang. Comparative analysis of clinical characteristics of neonates with purulent meningitis caused by different pathogens. 中国当代医药, 2020, 27(30): 13-17.
Brouwer MC，Tunkel AR，van de Beek D.Epidemiology，diagnosis，and antimicrobial treatment of acute bacterial meningitis[J].Clin Microbiol Rev，2010，23（3）：467-492.
[2]
Di Mauro A，Cortese F，Laforgia N，et al.Neonatal bacterial meningitis：a systematic review of European available data[J].Minerva Pediatr，2019，71（2）：201-208.
[6]
Lin MC，Chiu NC，Chi H，et al.Evolving trends of neonatal and childhood bacterial meningitis in northern Taiwan[J].J Microbiol Immunol Infect，2015，48（3）：296-301.
[8]
Kumar M，Tripathi S，Kumar H，et al.Predictors of Poor Outcome in Neonates with Pyogenic Meningitis in a Level-Three Neonatal Intensive Care Unit of Developing Country[J].J Trop Pediatr，2018，64（4）：297-303.
[9]
Ku LC，Boggess KA，Cohen-Wolkowiez M.Bacterial meningitis in infants[J].Clin Perinatol，2015，42（1）：29-45.
Bedetti L，Marrozzini L，Baraldi A，et al.Pitfalls in the diagnosis of meningitis in neonates and young infants：the role of lumbar puncture[J].J Matern Fetal Neonatal Med，2019，32（23）：4029-4035.
[12]
Cortese F，Scicchitano P，Gesualdo M，et al.Early and Late Infections in Newborns：Where Do We Stand?A Review[J].Pediatr Neonatol，2016，57（4）：265-273.
[13]
Tan J，Kan J，Qiu G，et al.Clinical Prognosis in Neonatal Bacterial Meningitis：The Role of Cerebrospinal Fluid Protein[J].PLoS One，2015，10（10）：e0141620.
[14]
El-Naggar W，Afifi J，McMillan D，et al.Epidemiology of Meningitis in Canadian Neonatal Intensive Care Units[J].Pediatr Infect Dis J，2019，38（5）：476-480.
de Gier B，van Kassel MN，Sanders EAM，et al.Disease burden of neonatal invasive Group B Streptococcus infection in the Netherlands[J].PLoS One，2019，14（5）：e0216749.
[17]
Whittaker R，Economopoulou A，Dias JG，et al.European Centre for Disease Prevention and Control Country Experts for Invasive Haemophilus influenzae Disease.Epidemiology of Invasive Haemophilus influenzae Disease，Europe，2007-2014[J].Emerg Infect Dis，2017，23（3）：396-404.
[18]
Zhao Z，Yu JL，Zhang HB，et al.Five-Year Multicenter Study of Clinical Tests of Neonatal Purulent Meningitis[J].Clin Pediatr （Phila），2018，57（4）：389-397.
[19]
Le Doare K，O′Driscoll M，Turner K，et al.Intrapartum Antibiotic Che-moprophylaxis Policies for the Prevention of Group B Streptococcal Disease Worldwide：Systematic Review[J].Clin Infect Dis，2017，65（2）：S143-S151.
[20]
Heath PT，Culley FJ，Jones CE，et al.Group B streptococcus and respiratory syncytial virus immunisation during pregnancy：a landscape analysis[J].Lancet Infect Dis，2017，17（7）：e223-e234.
[21]
Germovsek E，Lutsar I，Kipper K，et al.Plasma and CSF pharmacokinetics of meropenem in neonates and young infants：results from the NeoMero studies[J].J Antimicrob Chemother，2018，73（7）：1908-1916.
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