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中国一家三级医院儿科患者脑膜炎的临床转归和危险因素。

Clinical outcomes and risk factors of meningitis in pediatric patients at a tertiary hospital in China.

机构信息

Department of Infectious Diseases, Children's Hospital of Fudan University, National Children's Medical Center, Shanghai, China.

Lab of Microbiology, Department of Clinical Laboratory, Children's Hospital of Fudan University, National Children's Medical Center, Shanghai, China.

出版信息

Front Cell Infect Microbiol. 2024 Aug 29;14:1408959. doi: 10.3389/fcimb.2024.1408959. eCollection 2024.

Abstract

OBJECTIVES

To summarize the clinical characteristics, outcomes and identify risk factors of (AB) meningitis in children.

METHODS

This was a single-center, retrospective study. Children hospitalized between January 2016 and December 2021 who were diagnosed with AB meningitis were included. The clinical characteristics and outcomes were reviewed. Risk factors were determined using univariate analyses (chi-square and Mann-Whitney U tests).

RESULTS

Seventeen patients were included; 15 cases were secondary to neurosurgery, and two were neonates with primary bacterial meningitis. Common symptoms included fever, convulsions and nervous system abnormalities. Cerebrospinal fluid (CSF) tests typically showed increased white blood cell counts dominated by neutrophils, reduced glucose levels and elevated protein levels. Ten patients were successfully treated (successful treatment [ST] group); seven had failed treatment (failed treatment [FT] group). Univariate analyses revealed that mechanical ventilation, routine white cell counts in the peripheral blood, procalcitonin, protein in the CSF, septic shock and carbapenem-resistant AB (CRAB) differed significantly between the groups.

CONCLUSION

AB meningitis in children has a high mortality rate. FT was associated with mechanical ventilation, septic shock, CRAB, lower peripheral leukocyte counts, higher protein levels in the CSF and procalcitonin. Larger studies are needed to identify independent risk factors for adverse outcomes.

摘要

目的

总结儿童(AB)型脑膜炎的临床特征、结局,并确定其危险因素。

方法

这是一项单中心、回顾性研究。纳入 2016 年 1 月至 2021 年 12 月期间因 AB 型脑膜炎住院的患儿。回顾性分析其临床特征和结局。采用单因素分析(卡方检验和曼-惠特尼 U 检验)确定危险因素。

结果

共纳入 17 例患儿,其中 15 例继发于神经外科手术,2 例为新生儿原发性细菌性脑膜炎。常见症状包括发热、惊厥和神经系统异常。脑脊液(CSF)检查通常显示白细胞计数增加,以中性粒细胞为主,葡萄糖水平降低,蛋白水平升高。10 例患儿治疗成功(成功治疗 [ST] 组),7 例治疗失败(失败治疗 [FT] 组)。单因素分析显示,机械通气、外周血常规白细胞计数、降钙素原、CSF 蛋白、感染性休克和耐碳青霉烯类 AB(CRAB)在两组间差异有统计学意义。

结论

儿童 AB 型脑膜炎死亡率高。FT 与机械通气、感染性休克、CRAB、外周血白细胞计数较低、CSF 蛋白和降钙素原水平较高有关。需要更大规模的研究来确定不良结局的独立危险因素。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/10d1/11390632/dc8c3902e855/fcimb-14-1408959-g001.jpg

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