The Correlation Analysis Of Pathogen,Inflammation Index And Prognosis Of Bacterial Meningitis In Children

Objective 1.To grasp the clinical characteristics and the distribution of Bacterial Meningitis in central and western regions of Inner Mongolia.2.To explore the correlation between BM prognosis and the pathogenic bacteria,inflammatory marks within 72 hours after the attack as well as CSF inspection results.Methods 47 BM child patients that were hospitalized in Neonatology Department and pediatric internal medicine department of Inner Mongolia Maternal and Child Care Service Centre from January,2014 to June,2020.Essential information of the patients(age,gender,nationality,urban or rural);clinical manifestation(pyrexia,low psychiatric reaction,convulsion,emesis,disturbance of consciousness);inspection results of cranial imaging(CT/MRI),ratios of hemamebas and neutrophil granulocytes within 72 hours after the attack,Serum C-reactive protein,procalcitonin and the first examination of cerebrospinal fluid after being hospitalized(detection indexes include hemameba,lactate dehydrogenase,G immune globulin,blood sugar,protein and Chloride).6 months after the patients are discharged from hospital,we did a follow-up visit at Neurological Rehabilitation Clinic of Pediatric Department of the hospital to complete Gesell Developmental Scale or Wechsler Intelligence Scale for Children.Child patients with DQ(Developmental Quotient)≤85,IQ(Intelligence Quotient)﹤80 and sequelae such as hearing disorder,dyskinesia or secondary epilepsy are categorized as the unfavorable prognosis group,and patients without significant sequelae are categorized as the favorable prognosis group.We use two statistical descriptions:(X±SD)or P50(P25,P75)for measure materials and percentage calculation for count,and t/χ~2test for statistical inference.These statistical data of the two groups are compared to analyze risk factors of BM prognosis.We bring statistical indexes of single factor analysis into multi-factor logistic stepwise regression to find out independent risk factors that may cause unfavorable prognosis.In this process,we use two-sided tests for statistic analysis andα=0.05 for significant inspection level.Result 1.Essential information of the child patients:In 47 total cases that meet the criterion(except 9 loss to follow-up ones),among which 44 cases with integrated materials have completed the follow-up visit and 3 cases have died,by gender,there are 29 male cases(61.7%)and 18 female cases(38.3%)with male-female ratio:1.61:1;by age,there are 20 newborn(≤28 days)cases(42.6%),15 infant cases(34.0%),6 child cases aged 1-3 years old(12.8%)and 5 child cases aged or older than3 years old(10.6%);by nationality,there are 28 Han cases(59.6%)and 19 minority(Mongol Nationality,Manchu Nationality,the Hui Nationality and Daur Nationality)cases(40.4%);by region,there are 31 urban cases(66.0%)and 16 rural cases(34.0%)with the ratio:1.94:1.2.Clinical manifestations:42 pyrexia cases(89.4%),25disturbance of consciousness cases(53.2%),23 convulsion cases(48.9%),16 low psychiatric reaction cases(34.0%)and 12 emesis cases(25.5%).3.Etiologies:Main pathogens include streptococcus pneumoniae(29.8%),escherichia coli(25.5%),enterococcus faecium(14.9%),klebsiella pneumoniae(10.6%),other bacteria and etc.4.Risk factors related to prognosis:In this study,there are 32 favorable prognosis cases(68.1%)and 15 unfavorable prognosis cases(31.9%)in which 3 cases died(6.4%).By single factor study,it is found that convulsion(χ~2=5.248,P=0.022),disturbance of consciousness(χ~2=6.359,P=0.012),abnormal cranial imaging detection results(χ~2=4.372,P=0.037),CRP rising within 72 hours after the attack(t=2.139,P=0.038),PCT rising(Z=2.739,P=0.006),CSF-sugar reducing(t=2.741,P=0.009)and CSF-protein rising(t=2.361,P=0.023)(the first CSF detection result after being admitted to hospital)are related to unfavorable prognosis of BM.By multi-factor stepwise regression analysis,it is found that disturbance of consciousness(OR﹦12.51,95%CI:1.84-85.23),PCT rising(OR﹦3.88,95%CI:1.12-13.39)and CSF-sugar reducing(OR﹦0.40,95%CI:0.17-0.95)are independent risk factors of unfavorable prognosis.Conclusions 1.In central and western regions of Inner Mongolia,the greatest occurrence of BM is in those younger than 1 year old;male patients are the dominant and urban cases are more than rural cases.2.Streptococcus pneumoniae,escherichia coli and enterococcus faecium are major pathogen bacteria in these regions.3.Cardinal BM clinical manifestations include pyrexia,disturbance of consciousness,convulsion and low psychiatric reaction.4.Disturbance of consciousness,PCT rising within 72 hours after the attack and CSF-sugar reducing after being hospitalized are independent risk factors that influence prognosis.