Ben Hamouda H, Ben Haj Khalifa A, Hamza M A, Ayadi A, Soua H, Khedher M, Sfar M T
Unité de néonatologie, service de pédiatrie, hôpital Tahar Sfar, 5111 Mahdia, Tunisie.
Arch Pediatr. 2013 Sep;20(9):938-44. doi: 10.1016/j.arcped.2013.05.005. Epub 2013 Jul 2.
To study the epidemiological, clinical, and bacteriological aspects as well as the outcome of neonatal bacterial meningitis and analyze the factors of poor prognosis of this condition.
We report a retrospective analysis of 44 cases of neonatal bacterial meningitis hospitalized in the pediatric unit of Tahar Sfar Hospital in Mahdia, Tunisia, between January 1996 and December 2010. Inclusion criteria were infants less than 29 days of age who were hospitalized for bacterial meningitis diagnosed on either the presence of bacteria in cerebrospinal fluid or with more than 50 cells/mm(3), predominance of neutrophils, and the protein level greater than 1.2g/l. Clinical data were obtained through the analysis of patient files. Statistical analysis was based on the Chi(2) test, and P-values less than 0.05 were considered statistically significant.
The incidence of neonatal bacterial meningitis was 0.49 per 1000 live births. The patients were premature in 20.4 % and low birth weight in 13.6 % of cases. The clinical presentation was not specific for most cases. The main signs at admission were hyperthermia (43.2 %), refusal to nurse (20.4 %), seizures (18.2 %), and respiratory distress (13.6 %). The cerebrospinal fluid culture was positive in 36.4 % of cases. The group B streptococcus was the most frequently isolated (62.5 %) followed by Escherichia coli (12.5 %). The association of cefotaxime-ampicillin-gentamicin was used as the first treatment in all cases. Ofloxacin was associated with initial antibiotic therapy during the first 5 days in 20.4 % of cases. The mortality rate was 15.9 % and the rate of neurological sequelae in survivors was 21.6 %. Prematurity, low birth weight, shock, respiratory distress, and pleocytosis of less than 500 cells/mm(3) were the main factors of a poor prognosis. The addition of ofloxacin to the initial antibiotic therapy was associated with a decreased rate of neurological sequelae in survivors (11 % vs. 25 %, P=0.042).
This study emphasizes the severity of neonatal bacterial meningitis with high rates of mortality and neurological sequelae, especially in premature and low birth weight infants. An early diagnosis and effective antibiotic therapy is needed to improve the prognosis.
研究新生儿细菌性脑膜炎的流行病学、临床及细菌学特征以及预后情况，并分析该疾病预后不良的因素。
我们对1996年1月至2010年12月期间在突尼斯马赫迪耶塔哈尔·斯法尔医院儿科住院的44例新生儿细菌性脑膜炎病例进行了回顾性分析。纳入标准为年龄小于29天、因细菌性脑膜炎住院的婴儿，诊断依据为脑脊液中发现细菌，或细胞数超过50个/mm³、中性粒细胞占优势且蛋白水平大于1.2g/l。通过分析患者病历获取临床数据。统计分析采用卡方检验，P值小于0.05被认为具有统计学意义。
新生儿细菌性脑膜炎的发病率为每1000例活产儿0.49例。20.4%的患者为早产儿，13.6%的患者出生体重低。大多数病例的临床表现不具特异性。入院时的主要体征为发热（43.2%）、拒乳（20.4%）、惊厥（18.2%）和呼吸窘迫（13.6%）。36.4%的病例脑脊液培养呈阳性。B组链球菌是最常分离出的细菌（62.5%），其次是大肠杆菌（12.5%）。所有病例均首先使用头孢噻肟 - 氨苄西林 - 庆大霉素联合治疗。20.4%的病例在最初5天内将氧氟沙星与初始抗生素治疗联合使用。死亡率为15.9%，幸存者的神经后遗症发生率为21.6%。早产、低出生体重、休克、呼吸窘迫以及细胞数少于500个/mm³的脑脊液细胞增多是预后不良的主要因素。在初始抗生素治疗中添加氧氟沙星与幸存者神经后遗症发生率降低相关（11%对25%，P = 0.042）。
本研究强调了新生儿细菌性脑膜炎的严重性，其死亡率和神经后遗症发生率较高，尤其是在早产儿和低出生体重儿中。需要早期诊断和有效的抗生素治疗以改善预后。
