Zhu Minli, Lin Jing, Zhuge Zhangming, Zheng Yihui, Ye Shuyan, Wang Xun, Zhu Jianghu, Chen Shangqin, Lin Zhenlang
Key Laboratory of Perinatal Medicine of Wenzhou, Department of Neonatology, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, 325027, People's Republic of China.
Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York, NY, 10029, USA.
Infect Drug Resist. 2024 Nov 27;17:5277-5286. doi: 10.2147/IDR.S487757. eCollection 2024.
Neonatal bacterial meningitis (NBM) is a serious disease with high morbidity and mortality. This study aimed to establish a foundation for the selection of empirical antibiotics for NBM through an analysis of pathogen distribution and shift in antimicrobial resistant pattern.
A retrospective cohort study on culture confirmed NBM from 2005 to 2022.
A total of 191 cases were enrolled, 48 for premature infants and 70 for early-onset meningitis. The incidence of NBM in first half and last half period was 0.2‰ and 0.24‰, while the mortality was 12.0% and 5.6% respectively. The top two pathogens were () (40.3%) and (GBS) (29.8%). was the most common pathogen in both periods, (13.3% vs 0.9%, < 0.05) and (8.4% vs 1.9%, < 0.05) decreased, while GBS increased significantly in the periods [16.9% vs 39.8%, < 0.001]. Gram-positive bacteria were more common in full term infants (53.8% vs 27.1%, = 0.001), while gram-negative bacteria were more common in preterm infants (72.9% vs 46.2%, = 0.001). All isolated GBS strains were susceptible to penicillin. On the other hand, less than 60% of were susceptible to third generation of cephalosporins, and were only susceptible to carbapenem or amikacin. This was mainly due to production of extended-spectrum beta-lactamase (ESBLs) which was higher in late-onset group than that in early-onset group (45.1% vs 19.2%, = 0.026).
Incidence of NBM has not changed significantly over the last 2 decades. remains as the most common pathogen of NBM despite that GBS has increased in recent 9 years, especially in full-term infants. While all isolated GBS are susceptible to penicillin, over a third of strains are multidrug resistant due to production of ESBLs.
新生儿细菌性脑膜炎（NBM）是一种发病率和死亡率都很高的严重疾病。本研究旨在通过分析病原体分布及抗菌药物耐药模式的变化，为NBM经验性抗生素的选择奠定基础。
对2005年至2022年培养确诊的NBM进行回顾性队列研究。
共纳入191例病例，其中早产儿48例，早发型脑膜炎70例。上半年和下半年NBM的发病率分别为0.2‰和0.24‰，死亡率分别为12.0%和5.6%。前两位病原体是（）（40.3%）和B族链球菌（GBS）（29.8%）。在两个时期都是最常见的病原体，（13.3%对0.9%，P<0.05）和（8.4%对1.9%，P<0.05）减少，而GBS在[16.9%对39.8%，P<0.001]时期显著增加。革兰氏阳性菌在足月儿中更常见（53.8%对27.1%，P=0.001），而革兰氏阴性菌在早产儿中更常见（72.9%对46.2%，P=0.001）。所有分离出的GBS菌株对青霉素敏感。另一方面，不到60%的对第三代头孢菌素敏感，仅对碳青霉烯类或阿米卡星敏感。这主要是由于超广谱β-内酰胺酶（ESBLs）的产生，晚发型组高于早发型组（45.1%对19.2%，P=0.026）。
在过去20年中，NBM的发病率没有显著变化。尽管GBS在最近9年有所增加，尤其是在足月儿中，但仍然是NBM最常见的病原体。虽然所有分离出的GBS对青霉素敏感，但超过三分之一的菌株因产生ESBLs而多重耐药。
