中国当代儿科杂志2024，Vol.26Issue(2)：131-138,8.DOI:10.7499/j.issn.1008-8830.2308090
2019-2020年160例儿童肺炎链球菌脑膜炎临床流行病学多中心研究
A multi-center epidemiological study on pneumococcal meningitis in children from 2019 to 2020
摘要
Abstract
Objective To investigate the clinical characteristics and prognosis of pneumococcal meningitis(PM),and drug sensitivity of Streptococcus pneumoniae(SP)isolates in Chinese children.Methods A retrospective analysis was conducted on clinical information,laboratory data,and microbiological data of 160 hospitalized children under 15 years old with PM from January 2019 to December 2020 in 33 tertiary hospitals across the country.Results Among the 160 children with PM,there were 103 males and 57 females.The age ranged from 15 days to 15 years,with 109 cases(68.1% )aged 3 months to under 3 years.SP strains were isolated from 95 cases(59.4% )in cerebrospinal fluid cultures and from 57 cases(35.6% )in blood cultures.The positive rates of SP detection by cerebrospinal fluid metagenomic next-generation sequencing and cerebrospinal fluid SP antigen testing were 40% (35/87)and 27% (21/78),respectively.Fifty-five cases(34.4% )had one or more risk factors for purulent meningitis,113 cases(70.6% )had one or more extra-cranial infectious foci,and 18 cases(11.3% )had underlying diseases.The most common clinical symptoms were fever(147 cases,91.9% ),followed by lethargy(98 cases,61.3% )and vomiting(61 cases,38.1% ).Sixty-nine cases(43.1% )experienced intracranial complications during hospitalization,with subdural effusion and/or empyema being the most common complication[43 cases(26.9% )],followed by hydrocephalus in 24 cases(15.0% ),brain abscess in 23 cases(14.4% ),and cerebral hemorrhage in 8 cases(5.0% ).Subdural effusion and/or empyema and hydrocephalus mainly occurred in children under 1 year old,with rates of 91% (39/43)and 83% (20/24),respectively.SP strains exhibited complete sensitivity to vancomycin(100% ,75/75),linezolid(100% ,56/56),and meropenem(100% ,6/6).High sensitivity rates were also observed for levofloxacin(81% ,22/27),moxifloxacin(82% ,14/17),rifampicin(96% ,25/26),and chloramphenicol(91% ,21/23).However,low sensitivity rates were found for penicillin(16% ,11/68)and clindamycin(6% ,1/17),and SP strains were completely resistant to erythromycin(100% ,31/31).The rates of discharge with cure and improvement were 22.5% (36/160)and 66.2% (106/160),respectively,while 18 cases(11.3% )had adverse outcomes.Conclusions Pediatric PM is more common in children aged 3 months to under 3 years.Intracranial complications are more frequently observed in children under 1 year old.Fever is the most common clinical manifestation of PM,and subdural effusion/emphysema and hydrocephalus are the most frequent complications.Non-culture detection methods for cerebrospinal fluid can improve pathogen detection rates.Adverse outcomes can be noted in more than 10% of PM cases.SP strains are high sensitivity to vancomycin,linezolid,meropenem,levofloxacin,moxifloxacin,rifampicin,and chloramphenicol.[Chinese Journal of Contemporary Pediatrics,2024,26(2):131-138]关键词
肺炎链球菌/脑膜炎/流行病学/多中心研究/儿童Key words
Streptococcus pneumoniae/Meningitis/Epidemiology/Multicenter study/Child引用本文复制引用
王彩云,徐志伟,黄丽素,李海波,汪东,白松婷,单庆文,朱春晖,田健美,郝建华,林爱伟,许红梅,林道炯,吴谨准,张新华,曹清,陶仲宾,陈源,朱国龙,薛萍,汤正珍,苏学文,刘钢,曲政海,赵仕勇,庞琳,邓慧玲,舒赛男,陈英虎,刘静,俞蕙,陈必全,郑帼,舒敏,杜丽君..2019-2020年160例儿童肺炎链球菌脑膜炎临床流行病学多中心研究[J].中国当代儿科杂志,2024,26(2):131-138,8.基金项目
国家自然科学基金项目(82071812、82371829) （82071812、82371829）
中央引导地方科技发展专项(S20A0003). （S20A0003）
