Infection, Antimicrobials, Modelling, Evolution (IAME), Unité Mixte de Recherche (UMR) 1137, Institut National de la Santé Et de la Recherche Médicale IAME, UMR 1137, Université Paris Diderot, Sorbonne Paris Cité Assistance Publique - Hôpitaux de Paris (AP-HP), Laboratoire de Microbiologie, Centre National de Référence associé Escherichia coli AP-HP, Service de Pédiatrie Générale.
Infection, Antimicrobials, Modelling, Evolution (IAME), Unité Mixte de Recherche (UMR) 1137, Institut National de la Santé Et de la Recherche Médicale IAME, UMR 1137, Université Paris Diderot, Sorbonne Paris Cité Assistance Publique - Hôpitaux de Paris (AP-HP), Laboratoire de Microbiologie, Centre National de Référence associé Escherichia coli.
Clin Infect Dis. 2015 Sep 1;61(5):779-86. doi: 10.1093/cid/civ367. Epub 2015 May 5.
We aimed to describe features of Escherichia coli meningitis in a large population of children and the molecular characteristics of the involved strains to determine factors associated with severe disease or death.
Between 2001 and 2013, a prospective national survey collected data for 325 children hospitalized with E. coli meningitis. The national reference center genetically characterized 141 isolates.
Among the 325 cases, 65.2% were term, 22.4% late preterm, and 12.5% very/extremely preterm infants. Escherichia coli meningitis was 7-fold more frequent in preterm than term infants. Median age at diagnosis was 14 days; 71.1% of infants were neonates, with 2 peaks of infection at age 0-3 days (mostly preterm neonates) and 11-15 days (mostly term neonates); 8.9% were >89 days old. In total, 51.1% patients were considered to have severe disease, and 9.2% died. B2.1 phylogenetic subgroup (56%) and O1 serogroup (27.7%) were the most frequently identified. On multivariate analysis, death was associated with preterm birth (odds ratio [OR], 3.3 [95% confidence interval {CI}, 1.3-8.4], P = .015 for late preterm infants; OR, 7.3 [95% CI, 2.7-20.9], P < .001 for very/extremely preterm infants) and cerebrospinal fluid (CSF) to blood glucose ratio <0.10 (OR, 15.3 [95% CI, 1.8-128.3], P = .012). Death was associated with uncommon O serogroup strains (P = .014) and severe disease with O7 serogroup (P = .034) and PapGII adhesin (OR, 2.3 [95% CI, 1.2-4.5], P = .015).
In this large study of 325 cases of E. coli meningitis, risk factors of severe disease or death were preterm birth, severe hypoglycorrhachia, CSF/blood glucose ratio <0.10, and molecular characteristics of strains, which should help optimize therapeutic management.
本研究旨在描述大规模儿童群体中大肠埃希菌脑膜炎的特征，以及相关菌株的分子特征，以确定与严重疾病或死亡相关的因素。
在 2001 年至 2013 年期间，一项前瞻性全国性调查收集了 325 名因大肠埃希菌脑膜炎住院的儿童的数据。国家参考中心对 141 株分离株进行了基因特征分析。
在 325 例病例中，65.2%为足月，22.4%为晚期早产儿，12.5%为极早产儿/超低体重儿。与足月婴儿相比，早产儿中大肠埃希菌脑膜炎的发生率高 7 倍。中位发病年龄为 14 天；71.1%的婴儿为新生儿，感染有 2 个高峰，分别为 0-3 天（主要为早产儿）和 11-15 天（主要为足月儿）；8.9%的婴儿年龄大于 89 天。总的来说，51.1%的患者被认为患有严重疾病，9.2%的患者死亡。B2.1 进化分支群（56%）和 O1 血清群（27.7%）是最常见的。多因素分析显示，死亡与早产（比值比[OR]，3.3[95%置信区间{CI}，1.3-8.4]，P =.015 对于晚期早产儿；OR，7.3[95% CI，2.7-20.9]，P <.001 对于极早产儿/超低体重儿）和脑脊液（CSF）与血糖比值<0.10（OR，15.3[95% CI，1.8-128.3]，P =.012）相关。死亡与不常见的 O 血清群菌株相关（P =.014），严重疾病与 O7 血清群相关（P =.034），与 PapGII 黏附素相关（OR，2.3[95% CI，1.2-4.5]，P =.015）。
在这项对 325 例大肠埃希菌脑膜炎病例的大型研究中，严重疾病或死亡的危险因素是早产、严重低血糖、CSF/血糖比值<0.10 和菌株的分子特征，这有助于优化治疗管理。
