| Objective To analyze the characteristics of epidemiology,clinical manifestations,laboratory tests,pathogens,treatment and short-term prognosis of neonatal bacterial meningitis(NBM),explore the related factors affecting its short-term prognosis,for providing basis for clinical diagnosis and treatment.Methods Children diagnosed as NBM in Department of Neonatal Intensive Care Unit of Quanzhou Maternity and Children’s Hospital from January 2011 to December2020 were included.A retrospective questionnaire was designed to collect the data of basic characteristics,perinatal conditions,clinical manifestations,laboratory tests,treatment and short-term prognosis.According to the onset time of NBM,it was divided into early-onset group and late-onset group.According to the results of pathogen culture,it was divided into pathogen-positive group and pathogen-negative group.According to the short-term prognosis assessed by Glasgow outcome scale,it was divided into good prognosis and poor prognosis group.All data were analyzed and processed by statistical methods such as t-test,Mann-Whitney U test,chi-square test,continuous correction chi square test,unconditional multivariate logistic regression analysis and drawing ROC curve.When P<0.05,it was considered that the comparison between the two groups was statistically significant.Results1.A total of 294 cases of NBM were enrolled in the study,including 99 cases(33.7%)in the pathogen-positive group and 176 cases(59.9%)in the late-onset group.The total incidence of NBM within 10 years was 0.58%,and the incidence of pathogen-positive NBM was 0.19%;the total incidence of NBM from 2011 to 2015 was 0.29%,which rose to 0.90%from 2016 to 2020.2.Among 294 cases of NBM,61.9%were male,27.9%were born by cesarean section,17.7%were premature infants,13.3%were small for gestational age,the median gestational age was 39.0(38.0,40.0)weeks,and the median birth weight was 3100(2700,3450)g.In the perinatal period,46 cases of mothers with infectious diseases,accounting for 15.6%;38 cases of premature rupture of membranes≥18 hours,accounting for12.9%;and 47 cases of amniotic fluid muddy,accounting for 16.0%.The median age of NBM onset was 10(3,18)days;the median length of hospital stay was 19(14,29)days.Compared with the late-onset group,the early-onset group had a higher proportion of perinatal mother infection and premature infants,a smaller birth weight and gestational age,and a longer hospital stay,and the differences were statistically significant(P<0.05).Compared with the pathogen negative group,NBM in the pathogen positive group had a higher proportion of premature infants,smaller birth weight and longer hospital stay,and the differences were statistically significant(P<0.05).3.Fever was the first symptom in 75.2%of NBM and the presence of shortness of breath or grunting in 10.5%;both early onset and late-onset NBM had fever as the first symptom,but the proportion of late-onset cases was significantly higher than that of early-onset cases(88.1%vs.55.9%).Breathlessness or moaning ranked second in the first symptom of early-onset NBM,which was significantly higher than that of late-onset NBM(23.7%vs.1.7%).The proportion of pathogen-positive NBM with anorexia or poor response as the first symptom was higher than that in the pathogen-negative group,and the difference was statistically significance(P<0.05).The top 5 early clinical manifestations of NBM were fever in 242 cases(82.3%),anorexia or poor response in 65cases(22.1%),shortness of breath or grunting in 51 cases(17.3%),convulsion in 49 cases(16.7%),worsening jaundice in 32 cases(10.9%).The incidence of fever in the late-onset group was higher than that in the early-onset group.The incidence of shortness of breath or grunting and apnea in the early-onset group was higher than these in the late-onset group.The incidence of anorexia or poor response,convulsion,skin pattern and heart rate increase in the pathogen-positive group was higher than these in the pathogen-negative group,with statistically significance(P<0.05).4.The most abnormal laboratory tests for NBM after admission or within 72 hours after considering infection was 19.7%in the WBC<5×10~9/L group,the minimum was1.4×10~9/L;and 12.2%in the WBC>25×10~9/L group,the maximum was 76.2×10~9/L.The early-onset group was higher in the incidence of WBC>25×10~9/L,neutrophil ratio,hemoglobin,total bilirubin,aspartate aminotransferase,creatinine,CK and CK-MB than the late-onset group,platelets and alanine aminotransferase were lower than those in the late-onset group(P<0.05).The pathogen-positive group had a higher incidence of WBC<5×10~9/L,neutrophil ratio,CRP and PCT than the pathogen-negative group,and a lower incidence of normal WBC and lymphocyte ratio than the pathogen-negative group,there were statistically significant(P<0.05).5.In the first cerebrospinal fluid(CSF)examination of infants with NBM,the median of CSF-WBC was 310(79,1280)10×10~6/L,the minimum was 1×10~6/L,and the maximum was 146474×10~6/L.There was no difference in cerebrospinal fluid between early-onset NBM and late-onset NBM(P>0.05).Compared with pathogen-positive group and pathogen-negative groups,the former was higher in terms of CSF-WBC≥1000×10~6/L,CSF-WBC,multinucleated cell ratio and CSF-protein,and lower in terms of CSF-glucose and blood glucose CSF-glucose ratio,the difference were statistically significant(P<0.05).6.Blood culture was positive in 94 cases(32.0%),cerebrospinal fluid culture was positive in 25 cases(8.5%),and total pathogen was positive in 99 cases(33.7%).The top3 pathogens in the pathogen-positive group were group B streptococcus(GBS)(51.5%),Escherichia coli(25.3%)and Klebsiella pneumoniae(4.0%).GBS and Escherichia coli were both positive in CSF culture in 10 cases(40.0%).The top 2 pathogens of early-onset and late-onset NBM were GBS and Escherichia coli.Gram-positive bacteria were all sensitive to linezolid and vancomycin,6 penicillin-resistant strains were found,and GBS were all sensitive to penicillin.Gram-negative bacteria were both sensitive to ertapenem and piperacillin tazobactam,some strains were resistant to carbapenem antibiotics,Escherichia coli were all sensitive to ertapenem,imipenem,meropenem and piperacillin tazobactam.7.Antibiotic treatment of NBM lasted for 3 to 86 days,with a median of 17(13,28)days.The top 5 frequency of use were penicillin,ceftriaxone,meropenem,cephalosporin and vancomycin.The top 3 antibiotic combinations were penicillin combined with ceftriaxone,penicillin combined with meropenem and meropenem combined with vancomycin.There were 105 cases(35.7%)required respiratory support,106 cases(36.1%)were treated with gamma globulin,and 80 cases(27.2%)were treated with dexamethasone or methylprednisolone.8.The fatality rate of NBM was 3.1%(9/294).The craniocerebral MRI or CT was completed in 258 infants,and there were 105 cases with obvious imaging abnormalities.The top 5 abnormalities were:widening of the ventriculoencephalic space,hydrocephalus,ependymitis,encephalomalacia,and subdural effusion.According to the Glasgow prognosis grading evaluation system,the short-term prognosis of 258 infants with craniocerebral examination was assessed,by which 49 cases(19.0%)had poor prognosis and 209 cases(81.0%)had good prognosis.9.Multivariate binary Logistic regression analysis showed that pathogen-positive,convulsions,increased heart rate,CK-MB,CSF-glucose were independent risk factors for poor prognosis of NBM(P<0.05).The ROC curve was drawn for CK-MB to evaluate its predictive value in the poor prognosis of NBM.Its AUC was 0.628(95%confidence interval:0.512-0.705),P<0.05,and the optimal cut-off value was 24.5 U/L.The ROC curve of cerebrospinal fluid glucose was drawn to evaluate its predictive value in the poor prognosis of NBM.Its AUC was 0.809(95%confidence interval:0.738-0.879),P<0.05,and the optimal cut-off value was 1.29 mmol/L.Conclusions:The incidence of NBM showed an upward trend,the fatality rate was high,fever was the main clinical manifestation,the positive rate of pathogen culture was low,and GBS infection was the most common.Pathogen-positive,convulsions,increased heart rate,CK-MB and CSF-glucose were independent risk factors for poor prognosis in NBM.The optimal cut-off value of CSF-glucose in predicting poor prognosis in NBM was 1.29 mmol/L. |
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