河北省新生儿化脓性脑膜炎多中心流行病学研究

Epidemiology of neonatal purulent meningitis in Hebei Province, China: a multicenter study

摘要:

目的 了解新生儿化脓性脑膜炎的临床特征、诊断现状及主要致病菌、治疗转归等状况。方法 采用前瞻性临床流行病学研究方法, 收集2013~2014年连续12月间23家协作医院收治的患化脓性脑膜炎新生儿的临床资料, 对其临床特征及治疗转归等进行分析。结果 研究期间23家协作医院共收治新生儿脑膜炎病例301例。新生儿肺炎是最常见的原发疾病(167例, 55.5%)。临床表现以发热最常见(214例, 71.1%)。血培养阳性者72例(23.9%), 以大肠埃希菌、肺炎克雷伯菌、表皮葡萄球菌常见; 脑脊液培养阳性者36例, 占13.6%(36/264), 以大肠埃希氏菌、表皮葡萄球菌常见。脑脊液检查白细胞计数中位值为80个/mm³(范围0~92 500个/mm³), 其中11例(3.7%)<20个/mm³, >100个/mm³者154例(51.2%)。治愈及好转出院者258例(85.7%)。15例死亡, 病死率为5.0%(15/298)。结论 该地区新生儿化脓性脑膜炎最常见的原发疾病是新生儿肺炎; 最常见的临床表现是发热; 大肠埃希菌是导致该病的常见致病菌。仅凭脑脊液白细胞计数在正常范围不能除外该病。

Abstract:

Objective To investigate the clinical characteristics, diagnosis and main pathogenic bacteria, and outcomes of neonatal purulent meningitis. Methods A prospective epidemiological study was conducted in neonates with purulent meningitis admitted to 23 cooperating hospitals between 2013 and 2014. Clinical data were collected and clinical characteristics and outcomes were analyzed. Results A total of 301 neonates with purulent meningitis from the 23 cooperating hospitals were included. Neonatal pneumonia was the most common primary disease (167 cases, 55.5%). Fever was the most common manifestation (214 cases, 71.1%). Blood culture findings were positive in 72 patients (23.9%), with Escherichia coli, Klebsiella pneumoniae and Staphylococcus epidermidis as the most common bacteria. Positive cerebrospinal fluid (CSF) culture was found in 36 patients (36/264, 13.6%), with Escherichia coli and Staphylococcus epidermidis as the most common bacteria. The median of CSF WBC counts was 80/mm³ (range: 0-9 2500/mm³), and 11 cases (3.7%) had CSF WBC counts of <20/mm³ and 154 cases (51.2%) had CSF WBC counts of >100/mm³. There were 258 patients (85.7%) who were cured or improved at discharge and 15 deaths (15/298, 5.0%). Conclusions The most common primary disease of neonatal purulent meningitis is neonatal pneumonia in this area. The patients with neonatal purulent meningitis most often present with fever. Escherichia coli is the leading pathogenic bacteria causing neonatal purulent meningitis. A normal CSF WBC count can barely be used to exclude the possibility of this diosorder.