[A multicenter epidemiological study of neonatal bacterial meningitis in parts of South China].

To analyze the epidemiological characteristics (pathogenic bacteria distribution, clinical menifestations and outcomes) of neonatal bacterial meningitis in parts of Guangdong Province and Guangxi Zhuang Autonomous Region. A retrospective epidemiological study was carried out in the infants with bacterial meningitis admitted to 12 hospitals in Guangdong Province and Guangxi Zhuang Autonomous Region from January 2011 to December 2016. The distribution of pathogenic bacteria and epidemiological characteristics were analyzed during different periods (2011-2012, 2013-2014, 2015-2016), between early-onset and late-onset cases, preterm infants and term infants. Numeric variables between groups were compared with Student's test. Non-numeric variables were analyzed with χ(2) test. A total of 838 cases which met the criteria of neonatal bacterial meningitis were admitted during the study period, within which males were 545 and females were 293, with an average onset age of 8 (2, 16) days and diagnosed at the age of 14 (8, 20) days. Blood or CSF cultures were positive in 249 infants (29.7%), with (GBS), (), (CoNS) as the most common bacteria. The culture positive rate were 29.6% (47/159), 33.6% (85/253) and 27.5% (117/426) respectively in the periods of 2011-2012, 2013-2014, and 2015-2016, without significant differences among groups (χ(2)=2.860, 0.239). In the culture positive cases, there were no significant differences between the Gram-negative bacilli and Gram-positive cocci proportion in the three different periods (χ(2)=2.081, 0.353). The positive rates of cerebrospinal fluid (CSF) culture and blood culture were 33.0% (64/194) and 28.7% (185/644) in early-onset and late-onset bacterium meningitis infants (χ(2)=1.297, =0.255). The differences of Gram-negative bacilli and Gram-positive cocci proportion in the two groups were statistically significant (15/49 83/103, χ(2)=8.967, 0.003), while the most common bacteria was GBS in both groups. The positive rates of CSF culture and blood culture were 26.9% (57/212) and 30.7% (192/626) in preterm infants and term infants, without significant difference between the two groups (χ(2)=0.830, 0.362). While the differences of Gram-negative bacilli and Gram-positive cocci proportion in the two groups were significant (40/18 58/134, χ(2)=28.074, 0.000), with E. coli in preterm infants while GBS in term infants. There were 45 cases (5.4%) of which cerebrospinal fluid (CSF) WBC counts were less than 20×10(6)/L when bacterial meningitis was diagnosed, among them 5 cases had positive CSF culture; there were 728 cases (90.9%, 728/801) of CSF WBC≤20×10(6)/L at discharge. The positive rate of blood culture and CSF culture were both Lower in cases treated with antibiotics > 24 hours and≤24 hours before diagnosis, with significant difference (χ(2)=19.668, 0.000). Fever was the most common clinical manifestation (633 cases, 75.5%), and hydrocephalus was the most common complication (167 cases, 19.9%), which was seen more commonly in Gram-negative bacillus cases(χ(2)=4.190, =0.041). There were 801 infants (95.6%) who were cured or improved at discharge but 13 deaths (1.6%). The median course of antibiotic before and after diagnosis were 3 days and 20 days, respectively. Single antibiotics was used in 255 (30.4%), mainly meropenem (146 cases, 57.3%) or third generation cephalosporin (67 cases, 26.3%), while combination treatment was used in 583 cases(69.6%), mainly meropenem and third generation cephalosporin (302 cases, 51.8%), or Penicillin (or vancomycin) and third generation cephalosporin (115 cases, 19.7%). There was no significant difference in efficacy between single and combined antibiotics treatment groups ( all>0.05). The most common bacteria of neonatal bacterial meningitis were GBS, and CoNS in parts of South China. GBS was the most common pathogen in both early-onset and late-onset bacterial meningitis, also most common in term infants. While the most common bacteria in preterm infants was Fever was the most common clinical manifestation and hydrocephalus was the main complication. Neonatal bacterial meningitis should not be excluded if the CSF WBC is within normal range. The positive rate of CSF or blood culture decreased significantly if antibiotic is used more than 24 hours before diagnosis. Single antibiotics for sensitive bacteria is as effective as combined antibiotics treatment.