Erickson Timothy A, Munoz Flor M, Troisi Catherine L, Nolan Melissa S, Hasbun Rodrigo, Brown Eric L, Murray Kristy O
Department of Pediatrics, Section of Pediatric Tropical Medicine, William T. Shearer Center for Human Immunobiology, Baylor College of Medicine and Texas Children's Hospital, Houston, TX 77030, USA.
School of Public Health, University of Texas Health Science Center, Houston, TX 77030, USA.
Microorganisms. 2021 Mar 4;9(3):526. doi: 10.3390/microorganisms9030526.
Meningitis is associated with substantial morbidity and mortality, particularly in the first three months of life.
We conducted a retrospective review of patients <90 days of age with meningitis at Texas Children's Hospital from 2010-2017. Cases were confirmed using the National Healthcare Safety Network (NHSN) definition of meningitis.
Among 694 infants with meningitis, the most common etiology was viral ( = 351; 51%), primarily caused by enterovirus ( = 332; 95%). A quarter of cases were caused by bacterial infections ( = 190; 27%). The most common cause of bacterial meningitis was group B (GBS, = 60; 32%), followed by Gram-negative rods other than ( = 40; 21%), and ( = 37; 19%). The majority of Gram-negative organisms (63%) were resistant to ampicillin, and nearly one-fourth of Gram-negative rods (23%) other than and 2 (6%) isolates were resistant to third-generation cephalosporins. Significant risk factors for bacterial meningitis were early preterm birth and the Black race.
Enteroviruses most commonly caused viral meningitis in infants; GBS was the most common bacterial cause despite universal screening and intrapartum prophylaxis. The emergence of MRSA and resistance to third-generation cephalosporins in Gram-negative bacterial meningitis challenges the options for empirical antimicrobial therapy.
脑膜炎与严重的发病率和死亡率相关，尤其是在生命的头三个月。
我们对2010年至2017年在德克萨斯儿童医院就诊的90日龄以下脑膜炎患者进行了回顾性研究。病例根据国家医疗安全网络（NHSN）的脑膜炎定义确诊。
在694例脑膜炎婴儿中，最常见的病因是病毒感染（n = 351；51%），主要由肠道病毒引起（n = 332；95%）。四分之一的病例由细菌感染引起（n = 190；27%）。细菌性脑膜炎最常见的病因是B族链球菌（GBS，n = 60；32%），其次是除GBS外的革兰氏阴性杆菌（n = 40；21%）和肺炎链球菌（n = 37；19%）。大多数革兰氏阴性菌（63%）对氨苄西林耐药，除GBS外，近四分之一的革兰氏阴性杆菌（23%）和2%的肺炎链球菌分离株对第三代头孢菌素耐药。细菌性脑膜炎的重要危险因素是极早早产和黑人种族。
肠道病毒是婴儿病毒性脑膜炎最常见的病因；尽管进行了普遍筛查和产时预防，GBS仍是最常见的细菌病因。耐甲氧西林金黄色葡萄球菌的出现以及革兰氏阴性菌脑膜炎对第三代头孢菌素的耐药性给经验性抗菌治疗带来了挑战。
