Lin Pei-Ching, Chiu Nan-Chang, Li Wen-Chen, Chi Hsin, Hsu Chyong-Hsin, Hung Han-Yang, Kao Hsin-An, Huang Fu-Yuan
Department of Pediatrics, Mackay Memorial Hospital, Taipei, Taiwan, ROC.
J Microbiol Immunol Infect. 2004 Feb;37(1):35-8.
Nosocomial meningitis is uncommon in children. We reviewed the medical records of all children who developed bacterial meningitis at least 72 hours after admission to Mackay Memorial Hospital for the period July 1992 through June 2000. Clinical manifestations, predisposing factors, pathogens, and outcomes were analyzed. Twenty-two cases of nosocomial meningitis were identified, comprising 9.2% (22/239) of all pediatric cases of bacterial meningitis during the study period. The male-to-female ratio was 14:8. All patients were younger than 6 months of age except for one, who was 7 years old. The mean duration between admission and onset of meningitis was 15.3 days (range, 3 to 58 days). Twenty-two organisms were isolated, including 13 Gram-negative bacteria (59%) and 9 Gram-positive bacteria (41%). The most common pathogen was Escherichia coli (5 cases), followed by Enterobacter cloacae (3), Staphylococcus aureus (3), and Chryseobacterium meningosepticum (3). Seventeen patients (77%) had concomitant bacteremia. Predisposing factors for acquisition of nosocomial meningitis included previous treatment with broad-spectrum antibiotics (68%), prematurity with very low birth weight (41%), and total parenteral nutrition (32%). Two patients (9%) had previous neurosurgical intervention. Four patients (18%) died, 3 of whom were low birth weight premature infants. Nine patients (41%) had sequelae, including developmental delay, hydrocephalus, hearing impairment, and epilepsy. Neurosurgery was not a significant risk factor for the development of nosocomial meningitis, while very low birth weight played an important role. Previous intraventricular hemorrhage or hydrocephalus, prematurity with very low birth weight, infection with Gram-negative bacteria, and prior broad-spectrum antibiotic administration were associated with poor outcome.
医院获得性脑膜炎在儿童中并不常见。我们回顾了1992年7月至2000年6月期间入住麦凯纪念医院至少72小时后发生细菌性脑膜炎的所有儿童的病历。分析了临床表现、易感因素、病原体及转归。共确诊22例医院获得性脑膜炎病例，占研究期间所有儿童细菌性脑膜炎病例的9.2%（22/239）。男女比例为14:8。除1名7岁儿童外，所有患者年龄均小于6个月。入院至脑膜炎发病的平均时间为15.3天（范围3至58天）。分离出22种病原体，其中革兰阴性菌13种（59%），革兰阳性菌9种（41%）。最常见的病原体是大肠埃希菌（5例），其次是阴沟肠杆菌（3例）、金黄色葡萄球菌（3例）和脑膜败血金黄杆菌（3例）。17例患者（77%）合并菌血症。医院获得性脑膜炎的易感因素包括先前使用广谱抗生素治疗（68%）、极低出生体重的早产儿（41%）和全胃肠外营养（32%）。2例患者（9%）曾接受过神经外科手术干预。4例患者（18%）死亡，其中3例为低出生体重早产儿。9例患者（41%）有后遗症，包括发育迟缓、脑积水、听力障碍和癫痫。神经外科手术不是医院获得性脑膜炎发生的显著危险因素，而极低出生体重起重要作用。既往脑室内出血或脑积水、极低出生体重的早产儿、革兰阴性菌感染以及先前使用广谱抗生素与不良转归相关。
