中国极早产儿细菌性和真菌性脑膜炎的流行病学、微生物学及抗生素治疗：一项横断面研究

Epidemiology, microbiology and antibiotic treatment of bacterial and fungal meningitis among very preterm infants in China: a cross-sectional study.

作者信息

Cheng Ping, Qian Aimin, Zhang Hongbo, Wang Yingying, Li Shujuan, Sun Mengya, Yang Jie, Zhou Jianguo, Hu Liyuan, Lei Xiaoping, Hu Yu, Zhou Ligang, Du Lizhong, Cao Yun, Lee Shoo K, Zhou Wenhao, Kang Wenqing, Zhu Changlian, Sun Huiqing, Jiang Siyuan

机构信息

Department of Neonatology, Children's Hospital Affiliated to Zhengzhou University, Zhengzhou, Henan, China.

Department of Neonatology, Henan Key Laboratory of Child Brain Injury and Henan Pediatric Clinical Research Center, Third Affiliated Hospital and Institute of Neuroscience of Zhengzhou University, Zhengzhou, Henan, China.

出版信息

Arch Dis Child Fetal Neonatal Ed. 2025 Feb 21;110(2):219-225. doi: 10.1136/archdischild-2024-327495.

DOI:10.1136/archdischild-2024-327495

PMID:39299764

Abstract

OBJECTIVE

Neonatal meningitis significantly contributes to neonatal morbidity and mortality, yet large-scale epidemiological data in developing countries, particularly among very preterm infants (VPIs), remain sparse. This study aimed to describe the epidemiology of meningitis among VPIs in China.

DESIGN

Cross-sectional study using the Chinese Neonatal Network database from 2019 to 2021.

SETTING

79 tertiary neonatal intensive care units in China.

PATIENTS

Infants with gestational age <32 weeks or birth weight <1500 g.

MAIN OUTCOME MEASURES

Incidence, pathogen distribution, antimicrobial use and outcomes of bacterial and fungal meningitis.

RESULTS

Of 31 915 VPIs admitted, 122 (0.38%) infants were diagnosed with culture-confirmed meningitis, with 14 (11.5%) being early-onset (≤6 days of age) and 108 (88.5%) being late-onset (>6 days of age). The overall in-hospital mortality was 18.0% (22/122). A total of 127 pathogens were identified, among which 63.8% (81/127) were Gram-negative bacteria, 24.4% (31/127) were Gram-positive bacteria and 11.8% (15/127) were fungi. In terms of empirical therapy (on the day of the first lumbar puncture), the most commonly used antibiotic was meropenem (54.9%, 67/122). For definitive therapy (on the sixth day following the first lumbar puncture, 86 cases with available antibiotic data), meropenem (60.3%, 35/58) and vancomycin (57.1%, 16/28) were the most used antibiotics for Gram-negative and Gram-positive bacterial meningitis, respectively. 44% of infants with Gram-positive bacterial meningitis and 52% with Gram-negative bacterial meningitis received antibiotics for more than 3 weeks.

CONCLUSION

0.38% of VPIs in Chinese neonatal intensive care units were diagnosed with meningitis, experiencing significant mortality and inappropriate antibiotic therapy. Gram-negative bacteria were the predominant pathogens, with fungi emerging as a significant cause.

摘要

目的

新生儿脑膜炎是新生儿发病和死亡的重要原因，但发展中国家的大规模流行病学数据仍然匮乏，尤其是在极早产儿（VPI）中。本研究旨在描述中国VPI中脑膜炎的流行病学特征。

设计

采用2019年至2021年中国新生儿网络数据库进行横断面研究。

地点

中国79家三级新生儿重症监护病房。

研究对象

孕周<32周或出生体重<1500g的婴儿。

主要观察指标

细菌性和真菌性脑膜炎的发病率、病原体分布、抗菌药物使用情况及转归。

结果

在31915例入院的VPI中，122例（0.38%）婴儿被诊断为培养确诊的脑膜炎，其中14例（11.5%）为早发型（≤6日龄），108例（88.5%）为晚发型（>6日龄）。总体住院死亡率为18.0%（22/122）。共鉴定出127种病原体，其中63.8%（81/127）为革兰阴性菌，24.4%（31/127）为革兰阳性菌，11.8%（15/127）为真菌。在经验性治疗（首次腰椎穿刺当天）方面，最常用的抗生素是美罗培南（54.9%，67/122）。对于确定性治疗（首次腰椎穿刺后第6天，86例有可用抗生素数据），美罗培南（60.3%，35/58）和万古霉素（57.1%，16/28）分别是革兰阴性菌和革兰阳性菌脑膜炎最常用的抗生素。44%的革兰阳性菌脑膜炎婴儿和52%的革兰阴性菌脑膜炎婴儿接受抗生素治疗超过3周。