■分析临床流行病学特征,包括临床特征,肺炎球菌性脑膜炎(PM)的疾病预后,中国儿童肺炎链球菌分离株和药物敏感性。
■对临床,2019年1月至2020年12月,中国33家三级医院160名15岁以下PM住院儿童的实验室微生物数据。
■总共诊断出160名PM患者,其中男性103例,女性57例,发病年龄15天至15岁,中位年龄为1岁3个月。3个月至<5岁组137例(85.6%),特别是在3个月至<3岁年龄组(109例,68.2%);从脑脊液(CSF)培养中分离出肺炎链球菌95(35.6%),和57(35.6%)的血培养。CSF宏基因组下一代测序(mNGS)和抗原检测法检测肺炎链球菌的阳性率分别为40.2%(35/87)和26.9%(21/78)。55例(34.4%)有一种或多种细菌性脑膜炎的诱发因素;113例(70.6%)有一种或多种颅外感染性疾病发热(147例,91.9%)是最常见的临床症状,其次是呕吐(61,38.1%)和精神状态改变(47,29.4%)。在160名患有PM的儿童中,颅内影像学并发症主要为硬膜下积液和(或)脓胸43例(26.9%),脑积水24例(15.0%),脑脓肿23例(14.4%),颅内出血8例(5.0%),和其他脑血管疾病13例(8.1%),包括脑软化症,脑梗塞,和脑萎缩。硬膜下积液和(或)脓胸和脑积水主要发生在<1岁的儿童(90.7%(39/43)和83.3%(20/24),分别)。有17例PM(39.5%)颅内影像学异常超过1例。肺炎链球菌对万古霉素完全敏感(100.0%,75/75),利奈唑胺(100.0%,56/56),厄他培南(6/6);对左氧氟沙星高度敏感(81.5%,22/27),莫西沙星(14/17),利福平(96.2%,25/26),和氯霉素(91.3%,21/23);对头孢噻肟中度敏感(56.1%,23/41),美罗培南(51.1%,23/45)和头孢曲松(63.5,33/52);对青霉素较不敏感(19.6%,27/138)和克林霉素(1/19);对红霉素完全耐药(100.0%,31/31)。固化和改善率分别为22.5%(36/160)和66.3%(106/160),分别。18例(11.3%)有不良结局,包括6例退出治疗,5例未愈,5例死亡,和2次复发。肺炎链球菌对万古霉素完全敏感(100.0%,75/75),利奈唑胺(100.0%,56/56),和厄他培南(6/6);对头孢噻肟敏感,美罗培南,头孢曲松的比例为56.1%(23/41),51.1%(23/45),和63.5(33/52);对红霉素完全耐药(100.0%,31/31)。
■儿科PM在3个月至<3岁的儿童中更常见。颅内并发症主要发生在1岁以下儿童,发热是最常见的临床表现,硬膜下积液和(或)脓胸和脑积水是最常见的并发症,分别。CSF非培养方法有利于提高病原菌检出率。超过10%的PM儿童有不良后果。肺炎链球菌菌株对万古霉素敏感,利奈唑胺,厄他培南,左氧氟沙星,莫西沙星,利福平,和氯霉素.
UNASSIGNED: To analyze the clinical epidemiological characteristics including clinical features, disease prognosis of pneumococcal meningitis (PM), and drug sensitivity of S. pneumoniae isolates in Chinese children.
UNASSIGNED: A retrospective analysis was performed on the clinical, laboratory microbiological data of 160 hospitalized children less than 15 years of age with PM from January 2019 to December 2020 in 33 tertiary hospitals in China.
UNASSIGNED: A total of 160 PM patients were diagnosed, including 103 males and 57 females The onset age was 15 days to 15 years old, and the median age was 1 year and 3 months. There were 137 cases (85.6%) in the 3 months to <5 years age group, especially in the 3 months to <3 years age group (109 cases, 68.2%); S. pneumoniae was isolated from cerebrospinal fluid (CSF) culture in 95(35.6%), and 57(35.6%) in blood culture. The positive rates of S. pneumoniae detection by CSF metagenomic next-generation sequencing (mNGS)and antigen detection method were 40.2% (35/87) and 26.9% (21/78). Fifty-five cases (34.4%) had one or more predisposing factors of bacterial meningitis; and 113 cases (70.6%) had one or more extracranial infection diseases Fever (147, 91.9%) was the most common clinical symptom, followed by vomiting (61, 38.1%) and altered mental status (47,29.4%). Among 160 children with PM, the main intracranial imaging complications were subdural effusion and (or) empyema in 43 cases (26.9%), hydrocephalus in 24 cases (15.0%), cerebral abscess in 23 cases (14.4%), intracranial hemorrhage in 8 cases (5.0%), and other cerebrovascular diseases in 13 cases (8.1%) including encephalomalacia, cerebral infarction, and encephalatrophy. Subdural effusion and (or) empyema and hydrocephalus mainly occurred in children < 1 years old (90.7% (39/43) and 83.3% (20/24), respectively). 17 cases with PM (39.5%) had more than one intracranial imaging abnormality. S. pneumoniae isolates were completely sensitive to vancomycin (100.0%, 75/75), linezolid (100.0%,56/56), ertapenem (6/6); highly sensitive to levofloxacin (81.5%, 22/27), moxifloxacin (14/17), rifampicin (96.2%, 25/26), and chloramphenicol (91.3%, 21/23); moderately sensitive to cefotaxime (56.1%, 23/41), meropenem (51.1%, 23/45) and ceftriaxone (63.5, 33/52); less sensitive to penicillin (19.6%, 27/138) and clindamycin (1/19); completely resistant to erythromycin (100.0%, 31/31). The cure and improvement rate were 22.5% (36/160)and 66.3% (106/160), respectively. 18 cases (11.3%) had an adverse outcome, including 6 cases withdrawing treatment therapy, 5 cases unhealed, 5 cases died, and 2 recurrences. S. pneumoniae was completely susceptible to vancomycin (100.0%, 75/75), linezolid (100.0%, 56/56), and ertapenem (6/6); susceptible to cefotaxime, meropenem, and ceftriaxone in the order of 56.1% (23/41), 51.1% (23/45), and 63.5 (33/52); completely resistant to erythromycin (100.0%, 31/31).
UNASSIGNED: Pediatric PM is more common in children aged 3 months to < 3 years old. Intracranial complications mostly occur in children < 1 year of age with fever being the most common clinical manifestations and subdural effusion and (or) empyema and hydrocephalus being the most common complications, respectively. CSF non-culture methods can facilitate improving the detection rate of pathogenic bacteria. More than 10% of PM children had adverse outcomes. S. pneumoniae strains are susceptible to vancomycin, linezolid, ertapenem, levofloxacin, moxifloxacin, rifampicin, and chloramphenicol.