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.