Besner Anne-Sophie, Renaud Christian, Gravel Jocelyn
Faculty of Medicine, Université de Sherbrooke, Sherbrooke, Canada.
Department of Microbiology, Infectious Diseases and Immunology, CHU Sainte-Justine, Université de Montréal, Montréal, Canada.
Paediatr Child Health. 2024 Oct 20;30(2):83-91. doi: 10.1093/pch/pxae057. eCollection 2025 May.
This study aimed to identify the bacteria responsible for community-acquired bacterial meningitis in infants and children.
This was a retrospective cohort study including children aged 1 day to 18 years with confirmed bacterial meningitis, evaluated at a tertiary-care, Canadian emergency department between 2014 and 2022. The primary outcome was the pathogen identified. Other variables of interest were complications, age, and diagnostic method. Medical charts were reviewed by a co-investigator and 25% were assessed in duplicate.
All 79 eligible cases were included. The main causal agents were Group B (GBS) (n = 20; 25%), (n = 16; 20%), (n = 16; 20%), and (n = 9; 11%). Etiology exhibited age-dependent variations, with 85% of GBS and 100% of infections in children under 2 months. All pneumococcal and Group A cases were in children older than 6 months. All children infected by were vaccinated but the serotype was not covered by vaccination in 7/8 infections. All children with were either too young to be vaccinated (n = 10) or infected by a serotype not covered by the given vaccine. Fifty-five bacteria were identified by cerebrospinal fluid culture, 17 by Polymerase Chain Reaction (PCR), and 7 by both methods.
GBS is now the leading etiology of paediatric community-acquired bacterial meningitis at our centre. The etiology of bacterial meningitis varies greatly by age. Future studies should focus on improving the serotype spectrum of vaccines, identifying strategies to lower GBS infection, and improving the use of PCR as a diagnostic tool.
本研究旨在确定导致婴幼儿社区获得性细菌性脑膜炎的细菌。
这是一项回顾性队列研究，纳入了2014年至2022年期间在加拿大一家三级医疗急诊科确诊为细菌性脑膜炎的1日龄至18岁儿童。主要结局是鉴定出的病原体。其他感兴趣的变量包括并发症、年龄和诊断方法。医学图表由一名共同研究者进行审查，25%的图表进行了重复评估。
共纳入了全部79例符合条件的病例。主要病原体为B组链球菌（GBS）（n = 20；25%）、[此处原文缺失一种细菌名称]（n = 16；20%）、[此处原文缺失一种细菌名称]（n = 16；20%）和[此处原文缺失一种细菌名称]（n = 9；11%）。病因呈现出年龄依赖性差异，2个月以下儿童中85%为GBS感染，100%为[此处原文缺失一种细菌名称]感染。所有肺炎球菌和A组[此处原文缺失一种细菌名称]病例均发生在6个月以上儿童中。所有感染[此处原文缺失一种细菌名称]的儿童均接种了疫苗，但8例感染中有7例的血清型不在疫苗覆盖范围内。所有感染[此处原文缺失一种细菌名称]的儿童要么因年龄太小未接种疫苗（n = 10），要么感染的是给定疫苗未覆盖的血清型。通过脑脊液培养鉴定出55种细菌，通过聚合酶链反应（PCR）鉴定出17种，两种方法均鉴定出7种。
GBS目前是我们中心儿童社区获得性细菌性脑膜炎的主要病因。细菌性脑膜炎的病因因年龄而异。未来的研究应侧重于改善疫苗的血清型谱，确定降低GBS感染的策略，以及改进PCR作为诊断工具的应用。
