| Objective: To Analysis of the etiology and clinical characteristics of purulent meningitis in children, for helping in the diagnosis and treatment of childhood purulent meningitis.Methods: Collecting data for retrospective study on children with purulent meningitis at the Children’s Hospital Chongqing Medical University, from January 2006 to December 2015. The age, gender, clinical manifestations, routine blood test, cerebrospinal fluid, cranial imaging, electroencephalogram, pathogens and drug resistance, complications, treatment and outcomes were reviewed between 0~3 month age group and >3 month age group.Results:1. There were 203 children with purulent meningitis, their age ranged from 1h to 14 years old(Median, 40 days). 55.2% patients were younger than 3 months, in which 75.9% were newborns. 44.8% patients were older than 3 months, in which not more than 5 years of age accounted for 88.2%.2. Clinical manifestations of childhood purulent meningitis mainly included fever(80.3%), lethargy(72.9%), vomiting(42.9%), seizures(41.4%) and meningeal irritations(31.5%). There were statistic differences between the two age groups in the probabilities of fever, increased intracranial pressure and meningeal irritations(P<0.05).3. Routine blood test found that abnormal value of leukocytes accounted for 67.5%, more than 50% of neutrophils accounted for 78.3%; CRP>8mg/L accounted for 66.3%(122/184), PCT≥0.1ng/ml accounted for 87.9%(94/107).4. In 3120 children with purulent meningitis, the positive rate of CSF cultures was 2.9%, the positive rate of blood culture was 4.6%, there was statistic difference between the two age groups(P<0.05).5. According to the CSF cultures and/or blood cultures(more than 5 cases count positive), the main pathogens of the 0~3 month age group are Escherichia coli(41/112), Klebsiella pneumoniae subsp.pneumoniae(12/112), streptococcus agalactiae(11/112), staphylococcus epidermidis(9/112), staphylococcus haemolyticus(8/112) and staphylococcus aureus(5/112). The main pathogens of the >3 month age group are streptococcus pneumoniae(40/91), Escherichia coli(8/91) and staphylococcus aureus(6/91).6. In the aspect of drug resistance, positive rate of ESBL of Escherichia coli was 50%, the rates of drug resistance to ampicillin was 87.2%(41/47), to ceftriaxone was 100%(2/2), to cefotaxime was 58.3%(28/48), to cefepime was 48.9%(23/47), to ciprofloxacin was 40.4%(19/47), and no drug resistance were found to meropenem and imipenem. Positive rate of MLSB of streptococcus pneumoniae was 17.1%, the rates of drug resistance to penicillin was 60%(24/40), to ceftazidime was 80%(4/5), to cefepime was 36.4%(12/33). 97.5%(39/40) of streptococcus pneumoniae were sensitive to Vancomycin, and 73.5%(25/34) were sensitive to Meropenem, and no drug resistance were found to linezolid and levofloxacin.7. In all 203 children with purulent meningitis, 38.4% patients had complications, such as subdural effusion(20.2%), hydrocephalus(13.8%). Hearing impairment, visual impairment and ependymitis were also presented.8. In all 203 children with purulent meningitis, the outcome of 199 patients who were treated with antibiotics included: 49.8% of which were cured, 41.2% were improved and 9% showed no response. All the 18 patients with no response to antibiotics were complicated with septicemia, 3 of them were dead, the pathogens of the 18 patients were Escherichia coli, klebsiella pneumoniae pneumonia subspecies, streptococcus pneumoniae, pseudomonas aeruginosa and monocyte listeria.Conclusion:1. In all 203 children with purulent meningitis patients, the mobility was higher in children under 5 years old, especially in 0~3 month age group.2. The clinical features of young patients(0~3 month age group) were atypical, and the symptoms and signs such as fever, increased intracranial pressure and meningeal irritations are less common than >3 month age group.3. In addition to routine blood test which could be used as evaluation methods for purulent meningitis, CRP and PCT can also be effectively. The positive rate of Blood culture was higher than that of cerebrospinal fluid culture. Although blood culture is not the gold standard for diagnosis of purulent meningitis, it shouldn’t be ignored in clinical practice.4. The bacterial pathogens varies in different age groups, Escherichia coli was common in 0~3 month age group, and the streptococcus pneumoniae was common in >3 month age group. In the drug sensitive test, Escherichia coli had relatively higher resistance to Penicillins, three generations of cephalosporins, four generations of cephalosporins and quinolones, but it was sensitive to Carbapenems. Streptococcus pneumoniae had relatively higher resistance to Penicillins, three generations of cephalosporins, four generations of cephalosporins, but it was mostly sensitive to Vancomycin and Carbapenems.5. Subdural effusion and hydrocephalus were the most common complications. Hearing impairment, visual impairment and ventricle meningitis were also presented.6. Timely and effective antibiotics treatment could improve the prognosis of children with purulent meningitis, but there were nearly 1/10 children with poor prognosis in short-term prognosis. |
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