Single center clinical study on clinical characteristics and drug susceptibility of pneumococcal meningitis in children / 中华实用儿科临床杂志

ABSTRACT

Objective:To explore the clinical characteristics, drug resistance and the serotype distribution of the isolates from peadiatric patients with pneumococcal meningitis (PM).Methods:Clinical data, follow-up outcomes, drug susceptibility of isolated strains and serotyping results of 72 children diagnosed as PM and hospitalized in Beijing Children′s Hospital, Capital Medical University, from January 2012 to December 2017 were retrospectively analyzed, and the independent risk factors of mortality in the PM patients were analyzed.Results:There were 46 males and 26 females.In 72 PM cases, with the age ranging from 1 month to 9 years, and hospital stay from 1 to 363 days(median, 22.0 d). A total of 71 cases (98.6%) had community-acquired infections.There were 28 cases (38.9%) with definite underlying diseases, the top 3 of which were cerebrospinal fluid rhinorrhea(6 cases), head trauma (4 cases)and immunodeficiency diseases (4 cases). Fever (72 cases, 100.0%) was the most common clinical symptom, followed by depression of spirit, change of consciousness (46 cases, 63.9%), vomitting (45 cases, 62.5%), convulsion (42 cases, 58.3%), increased tension of anterior fontanelle (27 cases, 37.5%) and headache (17 cases, 23.6%) .There were 44 cases (61.1%) of neurological complications, including 29 cases (40.3%) of subdural effusion.Bacterial meningitis recurred in 2 cases, both of which were recurrent Streptococcus pneumoniae infection.The intracranial infections were divided into meningitis (43.1%, 31/72 cases) and meningoencephalitis (56.9%, 41/72 cases) .The penicillin nonsensitive rate of meningitis isolates was 74.3%, and their resistance rate to Erythromycin, Clindamycin and Tetracycline were 95.7%, 95.7% and 89.1%, respectively.All meningitis isolates were susceptible to Levofloxacin, Vancomycin and Linezolid.The serotypes of 24 cases (33.3%) were identified, among which 8 strains were type 19F (33.4%), 5 strains were type 14, 4 strains were type 23F, 3 strains were type 6A, 2 strains were type 19A, 1 strain was type 1 and 1 strain was type 15B, with a 13-valent protein-polysaccharide conjugate vaccine (PCV13) coverage rate of 95.8%(23/24 strains). Among all children that were followed up, 51 cases got better, 21 cases (case fatality rate was 29.2%) were confirmed dead, and 21 children (29.2%) had sequelae.The multiva-riate Logistic regression analysis suggested that respiratory failure and peripheral blood white blood cell count <4×10 9/L were independent risk factors for death of children with PM(all P<0.05). Conclusions:Most PM cases in this center are children under 5 years old.Cerebrospinal fluid rhinorrhea, head trauma and immunodeficiency diseases are common underlying diseases in children with PM.Respiratory failure or peripheral blood leukopenia during the course of the disease may indicate a poor prognosis.