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

Caiyun Wang; Hongmei XU; Jikui Deng; Hui YU; Yiping Chen; Aiwei Lin; Qing Cao; Jianhua Hao; Ting Zhang; Huiling Deng; Yinghu Chen

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

VernacularTitle: 儿童肺炎链球菌脑膜炎临床特征及药物敏感性多中心临床研究
Author: Caiyun WANG ¹ ; Hongmei XU ² ; Jikui DENG ³ ; Hui YU ⁴ ; Yiping CHEN ⁵ ; Aiwei LIN ⁶ ; Qing CAO ⁷ ; Jianhua HAO ⁸ ; Ting ZHANG ⁹ ; Huiling DENG ¹⁰ ; Yinghu CHEN ¹
Author Information

1. Department of Infectious Diseases, Children′s Hospital of Zhejiang University School of Medicine, Hangzhou 310052, China
2. Department of Infectious Diseases, Children′s Hospital of Chongqing Medical University, Chongqing 400014, China
3. Department of Infectious Diseases, Shenzhen Children′s Hospital, Shenzhen 518038, China
4. Department of Infectious Diseases, Children′s Hospital of Fudan University, Shanghai 201102, China
5. Department of Pediatric Infectious Diseases, Second Affiliated Hospital & Yuying Children′s Hospital of Wenzhou Medical University, Wenzhou 325027, China
6. Department of Infectious Diseases, Qilu Children′s Hospital of Shandong University, Jinan 250022, China
7. Department of Infectious Diseases, Shanghai Children′s Medical Center of Shanghai Jiaotong University School of Medicine, Shanghai 200127, China
8. Department of Infectious Diseases, Kaifeng Children′s Hospital, Kaifeng 475000, China
9. Department of Gastroenterology and Infectious Diseases, Children′s Hospital of Shanghai Jiaotong University School of Medicine, Shanghai 200040, China
10. Department of Infectious Diseases, Xi′an Children's Hospital, Xi′an 710003, China
Publication Type:Journal Article
Keywords: Streptococcus pneumoniae; Meningitis; Microbial senstivity tests; Multicenter study; Child
From: Chinese Journal of Pediatrics 2019;57(5):355-362
CountryChina
Language:Chinese
Abstract: 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 × 10⁹/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), χ²=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), χ²=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(χ²=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.