Gaschignard J, Levy C, Bingen E, Cohen R
Service de Pédiatrie générale, Université Paris Didérot, hôpital Robert Debré, 48, boulevard Serrurier, 75019 Paris, France.
Arch Pediatr. 2012 Nov;19 Suppl 3:S129-34. doi: 10.1016/S0929-693X(12)71286-1.
Neonatal bacterial meningitis has a mortality rate over 10 % and induces neurological sequellae in 20 to 50 % of cases. Escherichia coli (E. coli) is the second cause behind Group B streptococcus (GBS). The clinical and epidemiological features of neonatal meningitis due to E. coli between 2001 and 2010 with the data from the National Observatory are presented here.
Cases of child meningitis were prospectively collected since 2001 by a network of 252 pediatric wards associated with 166 microbiology laboratories. Risk factors, clinical signs, cerebrospinal fluid analysis, treatment and mortality were collected.
638 cases of neonatal bacterial meningitis were reported by 114 pediatric wards, among which 28 % (n=180) due to E. coli. If GBS prevailed in early and late-onset forms in term infants (84 % and 57 % for GBS vs 13 % and 28 % for E. coli), E. coli prevailed in preterm infants (42 % vs 37 % for GBS), and this trend increased in very preterm (GA < 33) (53 % vs 18 %). Number of E. coli early and late-onset meningitis didn't significantly vary over time. Antibiotherapy most often associated a 3(rd) generation cephalosporin, an aminosid and ciprofloxacin; sterilisation of the cerebrospinal fluid was achieved within day 2 to day 4 in 84 % of newborns. Only 3 strains were ESBL. Mortality was 11 % with E. coli, comparable to GBS (12 %) but reached 15 % in preterm infants.
E. coli was the prevailing cause of early and late onset bacterial meningitis in premature infants, associated with a higher mortality than in term infants.
新生儿细菌性脑膜炎死亡率超过10%，20%至50%的病例会引发神经后遗症。大肠杆菌（E. coli）是仅次于B族链球菌（GBS）的第二大病因。本文呈现了2001年至2010年期间来自国家监测站数据中，由大肠杆菌引起的新生儿脑膜炎的临床和流行病学特征。
自2001年起，由252个儿科病房与166个微生物实验室组成的网络前瞻性收集儿童脑膜炎病例。收集危险因素、临床体征、脑脊液分析、治疗情况及死亡率。
114个儿科病房报告了638例新生儿细菌性脑膜炎病例，其中28%（n = 180）由大肠杆菌引起。在足月儿的早发型和晚发型病例中GBS占主导（GBS分别为84%和57%，大肠杆菌分别为13%和28%），而在早产儿中大肠杆菌占主导（42%，GBS为37%），这种趋势在极早产儿（孕周<33周）中更为明显（53%，GBS为18%）。大肠杆菌早发型和晚发型脑膜炎的病例数随时间无显著变化。抗生素治疗最常联合使用第三代头孢菌素、氨基糖苷类药物和环丙沙星；84%的新生儿在第2天至第4天脑脊液实现除菌。仅3株为超广谱β-内酰胺酶（ESBL）菌株。大肠杆菌感染的死亡率为11%，与GBS相当（12%），但早产儿死亡率达15%。
大肠杆菌是早产儿早发型和晚发型细菌性脑膜炎的主要病因之一，与足月儿相比死亡率更高。
