Clinical features of neonatal purulent meningitis caused by different pathogens / 中国新生儿科杂志

ABSTRACT

Objective To analyze the clinical features of neonatal purulent meningitis (NPM caused by Gram-positive and Gram-negative bacteria.Method From January 2008 to December,2015,the clinical data of NPM with positive cerebrospinal-fluid (CSF) culture admitted to Children's Hospital of Fudan University were reviewed retrospectively.Patients were assigned into Gram-positive group and Gramnegative group according to CSF culture,and general information,clinical presentation,laboratory examination and outcome were compared between the two groups.Wilcoxon Rank-Sum test was used to compare means.Proportions were compared using x2 test.Result A total of 82 NPM patients with positive CSF culture were enrolled in the study,and 44 (53.7％) were male.The average gestational age was 38.5 (35.6,39.6) weeks and the mean birth weight was 3100 (2600,3380) grams.16 (19.5％) cases were early-onset meningitis and 66 (80.5％) were late-onset.In 82 cases,43 (52.4％) showed Gram-positive bacteria and 39 (47.6％) Gram-negative in CSF culture.The five most common pathogens were escherichia coli (22 cases,26.8％),group B streptococcus (GBS) (10 cases,12.2％),enterococcus faecium (8 cases,9.8％),coagulase-negative staphylococcus(8 cases,9.8％) and klebsiella pneumoniae (5 cases,6.1％).In early-onset patients,the main causative pathogens isolated from CSF were GBS (3 cases,18.8％) and enterococcus (3 cases,18.8％).Escherichia coli (20 cases,30.3％) and coagulase-negative staphylococcus (8 cases,12.1％) were the most common pathogens in late-onset patients.Gram-positive group and Gram-negative group had similar clinical presentation (P ＞ 0.05).The ratio of patients with blood C-reactive protein ＞ 8 mg/L in Gram-negative group was higher than that in Grampositive group (P ＜ 0.05).Those with Gram-negative bacterial meningitis had a higher incidence of hydrocephalus than Gram-positive (P ＜ 0.05).Conclusion The main pathogens of NPM are escherichia coli and GBS.Neonates with Gram-positive bacteria meningitis have similar clinical presentation with those with Gram-negative meningitis,but have different laboratory examination and complication characteristics.