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题名儿童急性细菌性脑膜炎多中心流行病学研究
其他题名A multicenter epidemiological study of acute bacterial meningitis in children
作者
发表日期2022
发表期刊中华儿科杂志   影响因子和分区
语种中文
原始文献类型Periodical
关键词儿童 脑膜炎，细菌性 流行病学 多中心研究
其他关键词Child ; Meningitis, bacterial ; Epidemiology ; Multicenter study
摘要目的:分析中国儿童急性细菌性脑膜炎（ABM）的病原菌组成、临床特征、疾病转归等临床流行病学特征。方法:回顾性分析2019年1月至2020年12月中国33家三级甲等医院住院<15岁的1 610例ABM患儿的病原菌分布、颅内影像学并发症、疾病转归等临床及实验室资料。按年龄分为<28日龄、28日龄至<3月龄、3月龄至<1岁、1~<5岁、5~<15岁组；根据临床特征及脑脊液检查指标，分为病原学确诊组及临床诊断组。组间比较采用χ 2检验、精确四格表法或非参数检验。 结果:1 610例ABM患儿中男955例、女650例，5例未提供性别信息；发病年龄1.5（0.5，5.5）月龄。<28日龄588例，28日龄至<3月龄462例，3月龄至<1岁302例，1~<5岁156例，5~<15岁101例，1例未提供年龄信息。<28日龄及28日龄组至<3月龄组常见病原菌为大肠埃希菌［检出率分别为38.8%（95/245）、31.5%（70/222）］和无乳链球菌［检出率分别为27.8%（68/245）、35.1%（78/222）］；3月龄至<1岁组常见病原菌为肺炎链球菌、大肠埃希菌、无乳链球菌，检出率依次为34.3%（61/178）、14.0%（25/178）及13.5%（24/178）；1~<5岁组及5~<15岁组患儿首位病原菌是肺炎链球菌，检出率分别为67.9%（74/109）及44.4%（16/36）。9.7%（19/195）的大肠埃希菌产生超广谱β-内酰胺酶。共收集脑脊液标本1 598例，脑脊液及血培养阳性率依次为32.2%（515/1 598）、25.0%（400/1 598），脑脊液宏基因组二代测序和肺炎链球菌抗原阳性率分别是38.2%（126/330）和25.3%（21/83）。4.3%（32/737）病原学确诊组患儿首次脑脊液白细胞计数正常。1 610例ABM患儿中常见的颅脑影像学并发症是硬膜下积液和（或）积脓349例（21.7%）、脑积水233例（14.5%）、脑脓肿178例（11.1%）和脑血管疾病（包含脑软化、脑梗死、脑萎缩）174例（10.8%）。不良结局166例（10.3%），其中死亡32例（2.0%），1岁内死亡24例；复发37例（2.3%），3周内复发25例。病原学确诊组ABM患儿硬膜下积液和（或）积脓、脑脓肿和脑室管膜炎发生率均明显高于临床诊断组［26.2%（207/790）比17.3%（142/820），13.0%（103/790）比9.1%（75/820），4.6%（36/790）比2.7%（22/820），χ 2=18.71、6.20、4.07，均 P<0.05］，两组间不良结局、死亡、疾病复发发生率差异均无统计学意义（均 P0.05）。 结论:儿童ABM的发病年龄多在<1岁，尤其是<3月龄。<3月龄患儿常见病原菌为大肠埃希菌、无乳链球菌，≥3月龄患儿首位病原菌是肺炎链球菌。硬膜下积液和（或）积脓、脑积水是常见并发症。首次脑脊液白细胞计数正常不能排除ABM。ABM病原学确诊患儿占比较低，临床还需重视和规范细菌学检查及提高病原检出率。脑脊液非培养检测方法可提高病原检出率。
其他摘要Objective:To analyze the clinical epidemiological characteristics including composition of pathogens , clinical characteristics, and disease prognosis acute bacterial meningitis (ABM) in Chinese children.Methods:A retrospective analysis was performed on the clinical and laboratory data of 1 610 children <15 years of age with ABM in 33 tertiary hospitals in China from January 2019 to December 2020. Patients were divided into different groups according to age,<28 days group, 28 days to <3 months group, 3 months to <1 year group, 1-<5 years of age group, 5-<15 years of age group; etiology confirmed group and clinically diagnosed group according to etiology diagnosis. Non-numeric variables were analyzed with the Chi-square test or Fisher′s exact test, while non-normal distrituction numeric variables were compared with nonparametric test.Results:Among 1 610 children with ABM, 955 were male and 650 were female (5 cases were not provided with gender information), and the age of onset was 1.5 (0.5, 5.5) months. There were 588 cases age from <28 days, 462 cases age from 28 days to <3 months, 302 cases age from 3 months to <1 year of age group, 156 cases in the 1-<5 years of age and 101 cases in the 5-<15 years of age. The detection rates were 38.8% (95/245) and 31.5% (70/222) of Escherichia coli and 27.8% (68/245) and 35.1% (78/222) of Streptococcus agalactiae in infants younger than 28 days of age and 28 days to 3 months of age; the detection rates of Streptococcus pneumonia, Escherichia coli, and Streptococcus agalactiae were 34.3% (61/178), 14.0% (25/178) and 13.5% (24/178) in the 3 months of age to <1 year of age group; the dominant pathogens were Streptococcus pneumoniae and the detection rate were 67.9% (74/109) and 44.4% (16/36) in the 1-<5 years of age and 5-<15 years of age . There were 9.7% (19/195) strains of Escherichia coli producing ultra-broad-spectrum β-lactamases. The positive rates of cerebrospinal fluid (CSF) culture and blood culture were 32.2% (515/1 598) and 25.0% (400/1 598), while 38.2% (126/330)and 25.3% (21/83) in CSF metagenomics next generation sequencing and Streptococcus pneumoniae antigen detection. There were 4.3% (32/790) cases of which CSF white blood cell counts were normal in etiology confirmed group. Among 1 610 children with ABM, main intracranial imaging complications were subdural effusion and (or) empyema in 349 cases (21.7%), hydrocephalus in 233 cases (14.5%), brain abscess in 178 cases (11.1%), and other cerebrovascular diseases, including encephalomalacia, cerebral infarction, and encephalatrophy, in 174 cases (10.8%). Among the 166 cases (10.3%) with unfavorable outcome, 32 cases (2.0%) died among whom 24 cases died before 1 year of age, and 37 cases (2.3%) had recurrence among whom 25 cases had recurrence within 3 weeks. The incidences of subdural effusion and (or) empyema, brain abscess and ependymitis in the etiology confirmed group were significantly higher than those in the clinically diagnosed group (26.2% (207/790) vs. 17.3% (142/820), 13.0% (103/790) vs. 9.1% (75/820), 4.6% (36/790) vs. 2.7% (22/820), χ 2=18.71, 6.20, 4.07, all P<0.05), but there was no significant difference in the unfavorable outcomes, mortility, and recurrence between these 2 groups (all P0.05). Conclusions:The onset age of ABM in children is usually within 1 year of age, especially <3 months. The common pathogens in infants <3 months of age are Escherichia coli and Streptococcus agalactiae, and the dominant pathogen in infant ≥3 months is Streptococcus pneumoniae. Subdural effusion and (or) empyema and hydrocephalus are common complications. ABM should not be excluded even if CSF white blood cell counts is within normal range. Standardized bacteriological examination should be paid more attention to increase the pathogenic detection rate. Non-culture CSF detection methods may facilitate the pathogenic diagnosis.
资助项目National Natural Science Foundation of China[82071812];Special Fund of the Central guiding local Scientific and Technological Development[S20A0003];
ISSN0578-1310
卷号60期号:10页码:1045-1053
DOI10.3760/cma.j.cn112140-20220608-00522
页数9
收录类别ISTIC ; PUBMED ; CNKI ; SCOPUS ; 维普 ; 北大核心 ; CSCD ; 万方
URL查看原文
PubMed ID36207852
SCOPUSEID2-s2.0-85154610694
维普分类号R742.9 ; R181.3
CN号11-2140/R
引用统计
文献类型期刊论文
条目标识符https://kms.wmu.edu.cn/handle/3ETUA0LF/166470
专题附属第二医院
作者单位
1.浙江大学医学院附属儿童医院感染科，杭州　310052;
2.重庆医科大学附属儿童医院感染科，重庆　400014;
3.首都医科大学附属北京儿童医院感染科，北京　100045;
4.湖南省儿童医院感染科，长沙　410007;
5.复旦大学附属儿科医院感染科，上海　201102;
6.安徽省儿童医院感染科，合肥　230022;
7.南京医科大学附属儿童医院神经内科，南京　210008;
8.四川大学华西第二医院儿科，成都　610044;
9.山西省儿童医院神经内科，太原　030006;
10.温州医科大学附属第二医院　育英儿童医院感染科，温州　325027;
11.上海交通大学医学院附属新华医院感染科，上海　200092;
12.吉林大学第一医院儿科，长春　130061;
13.西安交通大学附属儿童医院神经内科，西安　710002;
14.郑州大学第一附属医院儿科，郑州　450052;
15.广西医科大学第一附属医院儿科，南宁　530021;
16.江西省儿童医院感染科，南昌　330006;
17.苏州大学附属儿童医院感染科，苏州　215002;
18.开封市儿童医院感染科，开封　475000;
19.山东大学附属儿童医院感染科，济南　250022;
20.海南省妇女儿童医学中心感染科，海口　571103;
21.厦门大学附属妇女儿童医院儿科，厦门　361003;
22.山西省儿童医院新生儿科，太原　030006;
23.上海交通大学医学院附属上海儿童医学中心感染科，上海　200127;
24.兰州大学第一医院儿科，兰州　730013;
25.河北医科大学第二医院儿科，石家庄　050004;
26.青海省妇女儿童医院感染消化科，西宁　810007;
27.太原市妇幼保健院儿内科，太原　030012;
28.遵义市第一人民医院儿科，遵义　563099;
29.内蒙古自治区人民医院儿科，内蒙古　750306;
30.青岛大学附属医院儿科，青岛　266003;
31.杭州市儿童医院感染科，杭州　310005;
32.首都医科大学附属北京地坛医院儿科，北京　100102;
33.西安市中心医院儿科，西安　710004;
34.华中科技大学同济医学院附属同济医院儿科，武汉　430030
推荐引用方式
GB/T 7714		 王彩云,许红梅,田姣,等. 儿童急性细菌性脑膜炎多中心流行病学研究[J]. 中华儿科杂志,2022,60(10):1045-1053.
APA 王彩云., 许红梅., 田姣., 洪思琦., 刘钢., ... & 舒赛男. (2022). 儿童急性细菌性脑膜炎多中心流行病学研究. 中华儿科杂志, 60(10), 1045-1053.
MLA 王彩云,et al."儿童急性细菌性脑膜炎多中心流行病学研究".中华儿科杂志 60.10(2022):1045-1053.

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