Multicenter Retrospective Clinical Surver Of Neonatal Purulent Meningitis In China

Objective:To investigate the clinical characteristics,diagnosis and main pathogenic bacteria,and clinical outcomes of neonatal purulent meningitis in southwest and northwest region.In this study we probe whether shorter antibiotic treatment regimen for the negative cerebrospinal fluid(CSF)culture of neonatal bacterial meningitis in term infant is more meaningful and feasibility.Methods:A retrospective cohort study was conducted.From January2010 to December 2014,we enrolled neonates cases with bacterial meningitis admitted to 5 neonatology departments in Chongqing and ShanXi Province,China.Symptoms and signs,Laboratory tests,pathogen,imaging examinations,complications and outcome were collected and analyzed.Results were analyzed by Chi-square test and t-test.The level of significance considered was p<0.05.Results From January 2010 to December 2014,we enrolled 63514neonates admitted to 5 neonatology departments in Chongqing and Shan Xi Province,China,and 407 cases with bacterial meningitis.Neonatal bacterial meningitis was defined as clinical symptoms and signs of meningitis plus either a positive culture in the cerebrospinal fluid(CSF)or CSF WBC of>20×10~6/L in conjunction with a positive blood culture.In these cases with 62.65%were male.The mean gestational weeks were 38w and the mean birth weight was 3000g.30.71%were preterm,22.11%neonates with low birth weight(<2500g).77.64%within the late onset meningitis.Neonatalpneumonia,neonatalsepsis,pretermand hyperbilirubinemia of newborn were the most common primary disease.Fever,poor feeding and jaundice were the most common manifestation.Positive cultures of blood were obtained in 27.76%cases.With 61.06%cases were Gram-negative bacilli infections.The Escherichia coli.,Klebsiella pneumoniae as the most common bacteria.Positive cerebrospinal fluid culture was found in 6.88%cases,with Escherichia coli.as the most common bacteria.Intracranial hemorrhage and ventriculomegaly were most common in Neuroimaging.The median of CSF WBC counts was 78×10~6/L and CSF protein was 1685mg/L in preterm.The mean Hospital stay was21.97±14.32 days.Mean antibiotic treatment time were 19.49±9.93 days.The incidence of neonatal purulent meningitis were 0.64%the mortality were 9.09%and nervous system sequelae were 5.9%.In term infant the duration of antibiotic treatment range from 4 to 43 days,mean therapy time were 19.74±7.32 days and longer than 3 weeks for Neonatal bacterial meningitis with negative cerebrospinal fluid culture in term infant had no impact on prognosis(p>0.05).Conclusions From 2010 to 2014 the incidence of neonatal purulent meningitis were 0.64%mortality were 9.09%and nervous system sequelae were 5.9%.The most common primary disease of neonatal purulent meningitis is neonatal pneumonia.The patients with neonatal purulent meningitis most often present with fever.Escherichia coli.was the most common pathogenic bacteria causing neonatal purulent meningitis.and longer than 3 weeks for Neonatal bacterial meningitis with negative cerebrospinal fluid culture in term infant had no impact on prognosis.