中国多中心儿科肺炎球菌性脑膜炎临床流行病学研究：来自 2019-2020 年中国儿科细菌脑膜炎监测（CPBMS）的结果。
A multicenter clinical epidemiology of pediatric pneumococcal meningitis in China: results from the Chinese Pediatric Bacterial Meningitis Surveillance (CPBMS) 2019-2020.
机构信息
Department of Infectious Disease, Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, National Children's Regional Medical Center, Hangzhou, Zhejiang, China.
Department of Infectious Disease, Children's Hospital of Chongqing Medical University, Chongqing, China.
出版信息
Front Cell Infect Microbiol. 2024 Mar 15;14:1353433. doi: 10.3389/fcimb.2024.1353433. eCollection 2024.
OBJECTIVE
To analyze the clinical epidemiological characteristics including clinical features, disease prognosis of pneumococcal meningitis (PM), and drug sensitivity of isolates in Chinese children.
METHODS
A retrospective analysis was performed on the clinical, laboratory microbiological data of 160 hospitalized children less than 15 years of age with PM from January 2019 to December 2020 in 33 tertiary hospitals in China.
RESULTS
A total of 160 PM patients were diagnosed, including 103 males and 57 females The onset age was 15 days to 15 years old, and the median age was 1 year and 3 months. There were 137 cases (85.6%) in the 3 months to <5 years age group, especially in the 3 months to <3 years age group (109 cases, 68.2%); was isolated from cerebrospinal fluid (CSF) culture in 95(35.6%), and 57(35.6%) in blood culture. The positive rates of detection by CSF metagenomic next-generation sequencing (mNGS)and antigen detection method were 40.2% (35/87) and 26.9% (21/78). Fifty-five cases (34.4%) had one or more predisposing factors of bacterial meningitis; and 113 cases (70.6%) had one or more extracranial infection diseases Fever (147, 91.9%) was the most common clinical symptom, followed by vomiting (61, 38.1%) and altered mental status (47,29.4%). Among 160 children with PM, the main intracranial imaging complications were subdural effusion and (or) empyema in 43 cases (26.9%), hydrocephalus in 24 cases (15.0%), cerebral abscess in 23 cases (14.4%), intracranial hemorrhage in 8 cases (5.0%), and other cerebrovascular diseases in 13 cases (8.1%) including encephalomalacia, cerebral infarction, and encephalatrophy. Subdural effusion and (or) empyema and hydrocephalus mainly occurred in children < 1 years old (90.7% (39/43) and 83.3% (20/24), respectively). 17 cases with PM (39.5%) had more than one intracranial imaging abnormality. isolates were completely sensitive to vancomycin (100.0%, 75/75), linezolid (100.0%,56/56), ertapenem (6/6); highly sensitive to levofloxacin (81.5%, 22/27), moxifloxacin (14/17), rifampicin (96.2%, 25/26), and chloramphenicol (91.3%, 21/23); moderately sensitive to cefotaxime (56.1%, 23/41), meropenem (51.1%, 23/45) and ceftriaxone (63.5, 33/52); less sensitive to penicillin (19.6%, 27/138) and clindamycin (1/19); completely resistant to erythromycin (100.0%, 31/31). The cure and improvement rate were 22.5% (36/160)and 66.3% (106/160), respectively. 18 cases (11.3%) had an adverse outcome, including 6 cases withdrawing treatment therapy, 5 cases unhealed, 5 cases died, and 2 recurrences. was completely susceptible to vancomycin (100.0%, 75/75), linezolid (100.0%, 56/56), and ertapenem (6/6); susceptible to cefotaxime, meropenem, and ceftriaxone in the order of 56.1% (23/41), 51.1% (23/45), and 63.5 (33/52); completely resistant to erythromycin (100.0%, 31/31).
CONCLUSION
Pediatric PM is more common in children aged 3 months to < 3 years old. Intracranial complications mostly occur in children < 1 year of age with fever being the most common clinical manifestations and subdural effusion and (or) empyema and hydrocephalus being the most common complications, respectively. CSF non-culture methods can facilitate improving the detection rate of pathogenic bacteria. More than 10% of PM children had adverse outcomes. strains are susceptible to vancomycin, linezolid, ertapenem, levofloxacin, moxifloxacin, rifampicin, and chloramphenicol.
目的
分析中国儿童肺炎链球菌性脑膜炎（PM）的临床流行病学特征，包括临床特征、疾病预后和分离株的药敏性。
方法
回顾性分析 2019 年 1 月至 2020 年 12 月期间中国 33 家三级医院收治的 160 例年龄小于 15 岁的住院儿童 PM 患者的临床、实验室微生物学数据。
结果
共诊断 160 例 PM 患者，其中男性 103 例，女性 57 例，发病年龄为 15 天至 15 岁，中位年龄为 1 岁 3 个月。3 个月至<5 岁年龄组有 137 例（85.6%），特别是 3 个月至<3 岁年龄组有 109 例（68.2%）；从脑脊液（CSF）培养中分离出 95 株（35.6%），从血液培养中分离出 57 株（35.6%）。CSF 宏基因组下一代测序（mNGS）和抗原检测方法检测到 的阳性率分别为 40.2%（35/87）和 26.9%（21/78）。55 例（34.4%）有 1 种或多种细菌性脑膜炎的易患因素；113 例（70.6%）有 1 种或多种颅外感染性疾病。发热（147 例，91.9%）是最常见的临床症状，其次是呕吐（61 例，38.1%）和精神状态改变（47 例，29.4%）。在 160 例 PM 患儿中，主要颅内影像学并发症为硬膜下积液和（或）积脓 43 例（26.9%）、脑积水 24 例（15.0%）、脑脓肿 23 例（14.4%）、颅内出血 8 例（5.0%）和其他脑血管疾病 13 例（8.1%），包括脑软化、脑梗死和脑萎缩。硬膜下积液和（或）积脓和脑积水主要发生在<1 岁的儿童（90.7%（39/43）和 83.3%（20/24））。17 例 PM 患儿（39.5%）有超过 1 种颅内影像学异常。分离株对万古霉素（100.0%，75/75）、利奈唑胺（100.0%，56/56）、厄他培南（6/6）完全敏感；对左氧氟沙星（81.5%，22/27）、莫西沙星（14/17）、利福平（96.2%，25/26）和氯霉素（91.3%，21/23）高度敏感；对头孢噻肟（56.1%，23/41）、美罗培南（51.1%，23/45）和头孢曲松（63.5%，33/52）中度敏感；对青霉素（19.6%，27/138）和克林霉素（1/19）敏感性较低；对红霉素（100.0%，31/31）完全耐药。治愈和好转率分别为 22.5%（36/160）和 66.3%（106/160）。18 例（11.3%）出现不良结局，包括 6 例放弃治疗、5 例未愈、5 例死亡和 2 例复发。分离株对万古霉素（100.0%，75/75）、利奈唑胺（100.0%，56/56）和厄他培南（6/6）完全敏感；对头孢噻肟、美罗培南和头孢曲松的敏感性依次为 56.1%（23/41）、51.1%（23/45）和 63.5%（33/52）；对红霉素完全耐药（100.0%，31/31）。
结论
儿童 PM 多见于 3 个月至<3 岁的儿童。颅内并发症多发生在<1 岁的儿童，发热是最常见的临床表现，硬膜下积液和（或）积脓和脑积水是最常见的并发症。CSF 非培养方法有助于提高病原菌的检出率。超过 10%的 PM 患儿出现不良结局。肺炎链球菌对万古霉素、利奈唑胺、厄他培南、左氧氟沙星、莫西沙星、利福平、氯霉素敏感。
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