Clinical Analysis Of Nosocomial Bacterial Meningitis In Children

Objective : Nosocomial bacterial meningitis(NBM)is often acute onset,critical illness,serious neurological damage,which can lead to increased mortality,prolonged treatment time and increased treatment costs.At present,non-infectious factors such as craniocerebral trauma,edema,hemorrhage and stress can lead to fever,headache,meningeal irritation symptoms,and even the routine laboratory changes of blood and cerebrospinal fluid,which are difficult to distinguish from the clinical manifestations of nosocomial bacterial meningitis.In addition,due to the abuse of antibiotics,the positive rate of bacterial culture in cerebrospinal fluid for the diagnosis of central nervous system(CNS)infection is generally low.These problems lead to difficulties in the diagnosis of nosocomial bacterial meningitis,and affect the choice of antibiotics,when to start antibiotic treatment and other follow-up treatment decisions.Therefore,how to make a early correct diagnosis and take appropriate treatment measures in the early stage is particularly important to save the life and neurological function of patients.Therefore,this study used a retrospective analysis method to explore the clinical characteristics of nosocomial bacterial meningitis in children,so as to provide a basis for clinical diagnosis and treatment,as soon as possible to identify children with nosocomial bacterial meningitis,in order to improve the prognosis of children.Materials and Methods : A retrospective survey of 10 children with nosocomial bacterial meningitis admitted to the Pediatric Intensive Care Unit(PICU)of the First Affiliated Hospital of Zhengzhou University from January 2018 to February 2019,including patient’s general information(age,gender,etc.),clinical data(primary disease,past history,personal history,surgical history,condition changes,length of hospital stay,laboratory data,discharge outcome etc.).Test results(the number of white blood cells(WBC)in cerebrospinal fluid(CSF),classification,blood leukocyte count,C-reactive protein,etc.),diagnosis and treatment situation,invasive operation,types of pathogenic bacterial infection and drug resistance of pathogenic bacteria,etc.The prevalence of NBM was calculated.Results : 1.Ten out of 1259 children’s in PICU were diagnosed as nosocomial bacterial meningitis,with a prevalence rate of 0.8%.Among the 10 children with nosocomial bacterial meningitis,there were 5 males(50%)and 5 females(50%)with a median age of 1(0.42,9)years,a median hospital stay of 28.5(17,134)days and a median onset time of 7(4,18)days.2.Pathogenic bacteria and drug resistance: 2 out of 10 cases of nosocomial acquired bacterial meningitis were cultured positive,the bacterial detection rate was 20%,all of them were Gram-positive cocci,Streptococcus hemolyticus and Staphylococcus hominis subspecies;all of them were multidrug-resistant bacteria.3.Treatment and prognosis: The combination drugs were mainly used,vancomycin/rifamycin+ceftriaxone/meropenem.Nine cases were cured and discharged,accounting for 90%,and one case died,accounting for 10%.The main cause of death was multiple organ failure(MOF).Conclusion: 1.Nosocomial bacterial meningitis mainly occurs in patients with postoperative neurosurgery,patients with repeated lumbar puncture,and patients with moderate to severe head trauma.2.Pay attention to the changes of clinical symptoms and signs,and timely check the cerebrospinal fluid in order to get early diagnosis of patients with nosocomial meningitis in the hospital.3.The pathogens of nosocomial bacterial meningitis in the hospital are mostly multidrug resistant bacteria,and it is recommended to treat antibiotics(vancomycin/rifamycin+ceftriaxone/meropenem)according to the culture results.