An Esp Pediatr. 2002 Jun;56(6):556-63.
A prospective multicenter study was designed to assess the incidence, etiology, risk factors and outcomes of vertically transmitted and nosocomial meningitis in neonates over a two-year period.
Cases of neonatal meningitis diagnosed between January 1, 1997 and December 31, 1998 in the neonatology departments of 28 acute-care hospitals in Spain ("Grupo de Hospitales Castrillo") were prospectively studied. Bacteriological meningitis was considered confirmed when cerebrospinal fluid culture (CSF) was positive for bacteria, virus or fungi, probable when CSF culture was negative but blood culture was positive, and unconfirmed when both cultures were negative.
During the study period, 151 cases of meningitis were diagnosed. Transmission was vertical in 84 cases and nosocomial in 67. The incidence of vertically transmitted meningitis was 0.51 of live births, and was significantly higher in very low birth weight (VLBW) infants. Confirmed bacteriological meningitis was diagnosed in 66 patients (78.6 %). No risk factors were identified in 46.4 % of the patients. Group B Streptococcus (agalactiae) was isolated in 48.5 % of cases of confirmed meningitis and Escherichia coli was isolated in 18.2 %. In 69.7 % of cases the results of blood culture were in agreement with those of CSF culture. The overall mortality rate was 8.3 %; mortality was significantly higher in VLBW infants (33.3 % vs 4.2 % in infants weighing 1,500 g). Thirteen percent of survivors had sequelae. The incidence of meningitis of nosocomial transmission was 0.2 % of admissions and was more frequent in VLBW infants. Confirmed bacteriological meningitis was diagnosed in 49 patients (73.1 %). Two or more risk factors were present in 62.7 % of patients. E. coli was isolated in 26.5 % of cases of nosocomial meningitis and Staphylococcus epidermidis was isolated in 24.5 %. In 55 % of patients the results of blood culture agreed with those of CSF culture. The overall mortality rate was 19.4 %. Mortality was significantly higher in VLBW infants and 18.5 % of survivors showed sequelae.
The incidence, mortality and sequelae of neonatal meningitis in Spain were similar to those reported in recent studies. The most commonly isolated pathogens were group B Streptococcus in vertically transmitted meningitis and E. coli and S. epidermidis in nosocomial meningitis. We believe the distinction between vertical and nosocomial meningitis to be appropriate because the epidemiology of these diseases is different, which implies a different therapeutic approach. The high percentage of positive blood cultures indicates the need to include lumbar puncture whenever systemic infection is suspected in the neonatal period.
设计一项前瞻性多中心研究，以评估两年期间新生儿垂直传播性和医院获得性脑膜炎的发病率、病因、危险因素及转归。
对西班牙28家急症医院（“卡斯蒂略医院集团”）新生儿科在1997年1月1日至1998年12月31日期间诊断的新生儿脑膜炎病例进行前瞻性研究。当脑脊液培养（CSF）细菌、病毒或真菌阳性时，细菌性脑膜炎被认为确诊；当CSF培养阴性但血培养阳性时，为疑似；当两种培养均为阴性时，为未确诊。
研究期间，共诊断出151例脑膜炎病例。其中84例为垂直传播，67例为医院获得性。垂直传播性脑膜炎的发病率为每例活产0.51例，在极低出生体重（VLBW）婴儿中显著更高。确诊细菌性脑膜炎66例（78.6%）。46.4%的患者未发现危险因素。确诊脑膜炎病例中48.5%分离出B族链球菌（无乳链球菌），18.2%分离出大肠杆菌。69.7%的病例血培养结果与CSF培养结果一致。总体死亡率为8.3%；VLBW婴儿死亡率显著更高（33.3%对比体重1500g婴儿的4.2%）。13% 的幸存者有后遗症。医院获得性传播性脑膜炎的发病率为入院患者的0.2%，在VLBW婴儿中更常见。确诊细菌性脑膜炎49例（73.1%）。62.7%的患者存在两个或更多危险因素。医院获得性脑膜炎病例中26.5%分离出大肠杆菌，24.5%分离出表皮葡萄球菌。55%的患者血培养结果与CSF培养结果一致。总体死亡率为19.4%。VLBW婴儿死亡率显著更高，18.5%的幸存者有后遗症。
西班牙新生儿脑膜炎的发病率、死亡率和后遗症与近期研究报道相似。垂直传播性脑膜炎中最常分离出的病原体是B族链球菌，医院获得性脑膜炎中是大肠杆菌和表皮葡萄球菌。我们认为区分垂直传播性和医院获得性脑膜炎是恰当的，因为这些疾病的流行病学不同，这意味着治疗方法也不同。血培养阳性率高表明在新生儿期怀疑有全身感染时需要进行腰椎穿刺。
