A multicentric clinical study on clinical characteristics and drug sensitivity of children with pneumococcal meningitis in China

A multicentric clinical study on clinical characteristics and drug sensitivity of children with pneumococcal meningitis in China

Objective: To understand clinical characteristics of children with pneumococcal meningitis (PM) in China and to analyze the drug sensitivity of Streptococcus pneumoniae isolates and associated impacts on death and sequelae. Methods: The clinical data, follow-up results and antimicrobial sensitivity...

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Veröffentlicht in:Zhonghua er ke za zhi = Chinese journal of pediatrics. - 1960. - 57(2019), 5 vom: 02. Mai, Seite 355-362
1. Verfasser: Wang, C Y (VerfasserIn)
Weitere Verfasser: Xu, H M, Deng, J K, Yu, H, Chen, Y P, Lin, A W, Cao, Q, Hao, J H, Zhang, T, Deng, H L, Chen, Y H
Format: Online-Aufsatz
Sprache:Chinese
Veröffentlicht: 2019
Zugriff auf das übergeordnete Werk:Zhonghua er ke za zhi = Chinese journal of pediatrics
Schlagworte:Journal Article Child Meningitis Microbial senstivity tests Multicenter study Streptococcus pneumoniae Anti-Bacterial Agents Cefotaxime N2GI8B1GK7
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245 1 2 |a A multicentric clinical study on clinical characteristics and drug sensitivity of children with pneumococcal meningitis in China 
264 1 |c 2019 
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500 |a Date Revised 12.08.2019 
500 |a published: Print 
500 |a Citation Status MEDLINE 
520 |a Objective: To understand clinical characteristics of children with pneumococcal meningitis (PM) in China and to analyze the drug sensitivity of Streptococcus pneumoniae isolates and associated impacts on death and sequelae. Methods: The clinical data, follow-up results and antimicrobial sensitivity of isolated strains of 155 children (including 98 males and 57 females, age ranged from 2 months to 15 years) with PM in 10 tertiary-grade A class hospitals of Infectious Diseases Surveillance of Pediatrics (ISPED) from 2013 to 2017 were collected and analyzed retrospectively. Patients were divided into different groups according to the following standards: ≤1 year old group,>1-3 years old group and >3 years old group according to age; death group and non-death group according to the death within 30 days after PM diagnosis; complication group and non-complication group according to the abnormal cranial imaging diagnosis; sequelae group and no-sequelae group according to the follow-up results. Bonfereoni chi-square segmentation and Kruskal-Wallis H test were used for statistical analysis. Results: There were 64 cases (41.3%) in the ≤1 year old group, 39 cases in the >1-3 years old group (25.2%), and 52 cases (33.5%) in the >3 years old group. The most common clinical manifestation was fever (151 cases, 97.4%). The mortality was 16.8% (26/155) during hospitalization. The neurological complication rate was 49.7% (77/155) during hospitalization, including the most common complication, subdural effusion and (or) empyema in 50 cases (32.3%) and hearing impairment in 6 cases. During follow-up after discharge, no death was found and focal neurological deficits were found in 47 cases (30.3%), including the frequent neurological sequelae: cognitive and mental retardation of different degree in 22 cases and hearing impairment in 14 cases (9.0%). The rate of cure and improvement on discharge was 74.8% (116/155) and the lost to follow-up rate was 8.4% (13/155). The proportions of died cases, neurological complications during hospitalization and proportions of peripheral white blood cell count <12 × 10(9)/L before admission in ≤1 year old group were significantly higher than those in >3 years old group (25.0% (16/64) vs. 5.8% (3/52), 75.0% (48/64) vs. 25.0% (13/52), 48.4% (31/64) vs. 15.4% (8/52), χ(2)=7.747, 28.767, 14.044; P=0.005, 0.000, 0.000). The proportions of headache, vomiting, neck resistance and high risk factors of purulent meningitis in >3 years old group were significantly higher than those in ≤ 1 year old group (67.3%(35/52) vs. 1.6%(1/64), 80.8% (42/52) vs. 48.4% (31/64), 69.2% (36/52) vs. 37.5% (24/64), 55.8% (29/52) vs. 14.1%(9/64), χ(2)=57.940, 12.856, 11.568, 22.656; P=0.000, 0.000, 0.001, 0.000). Streptococcus pneumoniae isolates were completely sensitive to vancomycin (100.0%, 152/152), linezolid (100.0%, 126/126), moxifloxacin (100.0%, 93/93) and ofloxacin (100.0%,41/41); highly sensitive to levofloxacin (99.3%, 142/143) and ertapenem (84.6%, 66/78); moderately sensitive to ceftriaxone (48.4%, 45/93), cefotaxime (40.0%, 44/110) and meropenem (38.0%, 38/100); less sensitive to penicillin (19.6%, 27/138) and erythromycin (4.2%, 5/120). The proportions of non-sensitive strains of penicillin (21/21) and meropenem (17/18) in the death group were significantly higher than those (90/117, 45/82) in the survived group(χ(2)=4.648 and 9.808, P=0.031 and 0.002). Conclusions: The children's PM is mainly found in infants under 3 years old in China. Death and neurological complications are more common in PM children under 1 year old. The clinical manifestations and peripheral blood inflammatory markers of PM patients under 1 year old are not typical. Fever is the most common clinical manifestation and subdural effusion and (or) empyema is the most common complication. Long-term hearing impairment is common in PM and the follow-up time must be prolonged. The dead PM cases had high in sensitive rates to penicillin and meropenem 
650 4 |a Journal Article 
650 4 |a Child 
650 4 |a Meningitis 
650 4 |a Microbial senstivity tests 
650 4 |a Multicenter study 
650 4 |a Streptococcus pneumoniae 
650 7 |a Anti-Bacterial Agents  |2 NLM 
650 7 |a Cefotaxime  |2 NLM 
650 7 |a N2GI8B1GK7  |2 NLM 
700 1 |a Xu, H M  |e verfasserin  |4 aut 
700 1 |a Deng, J K  |e verfasserin  |4 aut 
700 1 |a Yu, H  |e verfasserin  |4 aut 
700 1 |a Chen, Y P  |e verfasserin  |4 aut 
700 1 |a Lin, A W  |e verfasserin  |4 aut 
700 1 |a Cao, Q  |e verfasserin  |4 aut 
700 1 |a Hao, J H  |e verfasserin  |4 aut 
700 1 |a Zhang, T  |e verfasserin  |4 aut 
700 1 |a Deng, H L  |e verfasserin  |4 aut 
700 1 |a Chen, Y H  |e verfasserin  |4 aut 
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