A multicenter epidemiological study of acute bacterial meningitis in children.

Cai Yun Wang; Hong Mei XU; Jiao Tian; Si Qi Hong; Gang Liu; Si Xuan Wang; Feng Gao; Jing Liu; Fu Rong Liu; Hui YU; Xia WU; Bi Quan Chen; Fang Fang Shen; Guo Zheng; Jie YU; Min Shu; Lu Liu; Li Jun DU; Pei LI; Zhi Wei XU; Meng Quan Zhu; Li Su Huang; He Yu Huang; Hai Bo LI; Yuan Yuan Huang; Dong Wang; Fang WU; Song Ting Bai; Jing Jing Tang; Qing Wen Shan; Lian Cheng Lan; Chun Hui Zhu; Yan Xiong; Jian Mei Tian; Jia Hui WU; Jian Hua Hao; Hui Ya Zhao; Ai Wei Lin; Shuang Shuang Song; Dao Jiong Lin; Qiong Hua Zhou; Yu Ping Guo; Jin Zhun WU; Xiao Qing Yang; Xin Hua Zhang; Ying Guo; Qing Cao; Li Juan Luo; Zhong Bin Tao; Wen Kai Yang; Yong Kang Zhou; Yuan Chen; Li Jie Feng; Guo Long Zhu; Yan Hong Zhang; Ping Xue; Xiao Qin LI; Zheng Zhen Tang; De Hui Zhang; Xue Wen SU; Zheng Hai QU; Ying Zhang; Shi Yong Zhao; Zheng Hong QI; Lin Pang; Cai Ying Wang; Hui Ling Deng; Xing Lou Liu; Ying Hu Chen; Sainan Shu

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A multicenter epidemiological study of acute bacterial meningitis in children.

Author: Cai Yun WANG ¹ ; Hong Mei XU ² ; Jiao TIAN ² ; Si Qi HONG ² ; Gang LIU ³ ; Si Xuan WANG ³ ; Feng GAO ¹ ; Jing LIU ⁴ ; Fu Rong LIU ⁴ ; Hui YU ⁵ ; Xia WU ⁵ ; Bi Quan CHEN ⁶ ; Fang Fang SHEN ⁶ ; Guo ZHENG ⁷ ; Jie YU ⁷ ; Min SHU ⁸ ; Lu LIU ⁸ ; Li Jun DU ⁹ ; Pei LI ⁹ ; Zhi Wei XU ¹⁰ ; Meng Quan ZHU ¹⁰ ; Li Su HUANG ¹¹ ; He Yu HUANG ¹¹ ; Hai Bo LI ¹² ; Yuan Yuan HUANG ¹² ; Dong WANG ¹³ ; Fang WU ¹³ ; Song Ting BAI ¹⁴ ; Jing Jing TANG ¹⁴ ; Qing Wen SHAN ¹⁵ ; Lian Cheng LAN ¹⁵ ; Chun Hui ZHU ¹⁶ ; Yan XIONG ¹⁶ ; Jian Mei TIAN ¹⁷ ; Jia Hui WU ¹⁷ ; Jian Hua HAO ¹⁸ ; Hui Ya ZHAO ¹⁸ ; Ai Wei LIN ¹⁹ ; Shuang Shuang SONG ¹⁹ ; Dao Jiong LIN ²⁰ ; Qiong Hua ZHOU ²⁰ ; Yu Ping GUO ²⁰ ; Jin Zhun WU ²¹ ; Xiao Qing YANG ²¹ ; Xin Hua ZHANG ²² ; Ying GUO ²² ; Qing CAO ²³ ; Li Juan LUO ²³ ; Zhong Bin TAO ²⁴ ; Wen Kai YANG ²⁴ ; Yong Kang ZHOU ²⁴ ; Yuan CHEN ²⁵ ; Li Jie FENG ²⁵ ; Guo Long ZHU ²⁶ ; Yan Hong ZHANG ²⁶ ; Ping XUE ²⁷ ; Xiao Qin LI ²⁷ ; Zheng Zhen TANG ²⁸ ; De Hui ZHANG ²⁸ ; Xue Wen SU ²⁹ ; Zheng Hai QU ³⁰ ; Ying ZHANG ³⁰ ; Shi Yong ZHAO ³¹ ; Zheng Hong QI ³¹ ; Lin PANG ³² ; Cai Ying WANG ³² ; Hui Ling DENG ³³ ; Xing Lou LIU ³⁴ ; Ying Hu CHEN ¹ ; Sainan SHU ³⁴
Author Information

1. Department of Infectious Diseases, Children's Hospital, 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, Beijing Children's Hospital, Capital Medical University, Beijing 100045, China.
4. Department of Infectious Diseases, Hunan Children's Hospital, Changsha 410007, China.
5. Department of Infectious Diseases, Children's Hospital of Fudan University, Shanghai 201102, China.
6. Department of Infectious Diseases, Anhui Provincial Children's Hospital, Hefei 230022, China.
7. Department of Neurology, Children's Hospital of Nanjing Medical University,Nanjing 210008, China.
8. Department of Pediatrics, West China Second University Hospital, Sichuan University, Chengdu 610044, China.
9. Department of Neurology, Children's Hospital of Shanxi, Taiyuan 030006, China.
10. Department of Infectious Diseases, the Second Affiliated Hospital & Yuying Children's Hospital of Wenzhou Medical University, Wenzhou 325027, China.
11. Department of Infectious Diseases, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200092, China.
12. Department of Pediatrics, the First Hospital of Jilin University, Changchu 130061, China.
13. Department of Neurology, the Affiliated Children's Hospital of Xi'an Jiao Tong University, Xi'an 710002, China.
14. Department of Pediatrics, the First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, China.
15. Department of Pediatrics, the First Affiliated Hospital of Guangxi Medical University,Nanning 530021, China.
16. Department of Infectious Diseases, Jiangxi Provincial Children's Hospital, Nanchang 330006, China.
17. Department of Infectious Diseases, Children's Hospital of Soochow University,Suzhou 215002, China.
18. Department of Infectious Diseases, Kaifeng Children's Hospital, Kaifeng 475000, China.
19. Department of Infectious Diseases, Children's Hospital Affiliated Shandong University, Jinan 250022, China.
20. Department of Infectious Diseases, Hainan Women and Children's Medical Center, Haikou 571103, China.
21. Department of Pediatrics, Women's and Children's Hospital Affiliated to Xiamen University, Xiamen 361003, China.
22. Department of Neonatology, Children's Hospital of Shanxi, Taiyuan 030006, China.
23. Department of Infectious Diseases, Shanghai Children's Medical Center, Shanghai Jiao Tong University School of Medicine, Shanghai 200127, China.
24. Department of Pediatrics, the First Hospital of Lanzhou University, Lanzhou 730013, China.
25. Department of Pediatrics, the Second Hospital of Hebei Medical University, Shijiazhuang 050004, China.
26. Department of Infection and Digestive, Qinghai Province Women and Children's Hospital, Xining 810007, China.
27. Department of Pediatrics, Taiyuan Maternal and Child Health Care Hospital, Taiyuan 030012, China.
28. Department of Pediatrics, the First People's Hospital of Zunyi, Zunyi 563099, China.
29. Department of Pediatrics, Inner Mongolia People's Hospital, Inner Mongolia 750306, China.
30. Department of Pediatrics, the Affiliated Hospital of Qingdao University, Qingdao 266003, China.
31. Department of Infectious Diseases, Hangzhou Children's Hospital, Hangzhou 310005, China.
32. Department of Pediatrics, Beijing Ditan Hospital, Capital Medical University, Beijing 100102, China.
33. Department of Pediatrics, Xi'an Central Hospital, Xi'an 710004, China.
34. Department of Pediatrics, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China.
Publication Type:Multicenter Study
MeSH: Adolescent; Brain Abscess; Child; Child, Preschool; Escherichia coli; Female; Humans; Hydrocephalus; Infant; Infant, Newborn; Male; Meningitis, Bacterial/epidemiology*; Retrospective Studies; Streptococcus agalactiae; Streptococcus pneumoniae; Subdural Effusion; beta-Lactamases
From: Chinese Journal of Pediatrics 2022;60(10):1045-1053
CountryChina
Language:Chinese
Abstract: 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), χ²=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 P>0.05). 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.