OBJECTIVETo investigate the differences in clinical features of childhood purulent meningitis (PM) caused by Escherichia coli and Streptococcus pneumoniae, and to provide help for the selection of antibiotics for PM children with unknown etiology.

METHODSA retrospective analysis was performed for the clinical data of children with PM caused by Escherichia coli (12 children) or Streptococcus pneumoniae (15 children).

RESULTSCompared with the Streptococcus pneumoniae infection group, the Escherichia coli infection group had a significantly higher proportion of children with an age of onset of <3 months and a significantly higher incidence rate of convulsion, but significantly lower incidence rates of severe fever (>39°C) and disturbance of consciousness and a significantly lower proportion of children with an increased leukocyte count at diagnosis (>12×10(9)/L). The results of routine cerebrospinal fluid test and biochemical examinations showed no significant differences between the two groups. Escherichia coli and Streptococcus pneumoniae were resistant to cephalosporins and had a sensitivity to chloramphenicol more than 90%. Escherichia coli was fully sensitive to meropenem and Streptococcus pneumoniae was fully sensitive to vancomycin.

CONCLUSIONSPM caused by Escherichia coli and Streptococcus pneumoniae has different clinical features. As for PM children with severe fever, disturbance of consciousness, and an increased leukocyte count, the probability of Streptococcus pneumoniae infection should be considered. For PM children with an age of onset of <3 months, medium- and low-grade fever, frequent convulsions, and a leukocyte count of <12×10(9)/L, the probability of Escherichia coli infection should be considered.

Adolescent ; Child ; Child, Preschool ; Female ; Humans ; Infant ; Infant, Newborn ; Male ; Meningitis, Escherichia coli ; diagnosis ; drug therapy ; Meningitis, Pneumococcal ; diagnosis ; drug therapy ; Microbial Sensitivity Tests ; Retrospective Studies ; Suppuration

OBJECTIVENeonatal purulent meningitis is a severe infection responsible for high mortality and disabling sequelae. Escherichia coli is the main pathogen of neonatal purulent meningitis. This study explored the clinical characteristics and antibiotic resistance of Escherichia coli-induced neonatal meningitis.

METHODSA retrospective chart review was performed. A total of 31 cases of neonatal purulent meningitis caused by Escherichia coli were identified in the neonatal intensive care unit between January 1, 2001 and December 31, 2011. The clinical characteristics and antibiotic sensitivity test results were analyzed.

RESULTSFever, poor feeding, lethargy and seizure were common clinical signs of neonatal purulent meningitis caused by Escherichia coli. Acute complications mainly included hyponatremia (17 cases), hydrocephalus (8 cases), subdural collection (2 cases), ventriculitis (2 cases) and cerebral infarction (1 case). Thirty neonates (97%) had increased CRP levels. Of the 31 patients, 14 cases were cured and 12 had adverse outcomes (5 patients died during hospitalization). Escherichia coli strains were resistant (>50%) to commonly used penicillins and cephalosporins between 2007 and 2011, presenting significantly higher resistance rates than between 2001 and 2006. The detection rate of extended spectrum β-lactamases (ESBLs)-producing strains between 2007 and 2011 increased significantly compared with between 2001 and 2006 (57% vs 0).

CONCLUSIONSThe clinical manifestations of neonatal purulent meningitis caused by Escherichia coli are non specific. The outcome is poor. Monitoring of CRP levels is valuable for the early diagnosis of neonatal purulent meningitis. The antimicrobial resistance rates of Escherichia coli are increasing, especially to cephalosporins. The percentage of ESBLs-producing strains is increasing over the years.

C-Reactive Protein ; analysis ; Drug Resistance, Bacterial ; Female ; Humans ; Infant, Newborn ; Male ; Meningitis, Escherichia coli ; drug therapy ; pathology ; Microbial Sensitivity Tests ; Retrospective Studies ; Suppuration ; drug therapy

OBJECTIVETo analyze risk factors, clinical features, outcomes and antibiotic resistance of Escherichia coli(E.coli) causing bloodstream infections in children.

METHODAll inpatients with E. coli positive blood culture in Beijing Children's Hospital from January 2012 to May 2014 were enrolled; 112 cases were included, 66 cases (58.9%) were male, and 46 cases(41.1%) were female. Age range was 2 days to 16 years. Among them, 43 cases (38.4%) were neonates, 19 cases (17.0%) aged from 1 month to 1 year, 14 cases (12.5%) were 1-3 years old, and 36 cases (32.1%) were over three years old. We analyzed the divisions to which the patients were admitted, source of infection, underlying diseases, clinical characteristics, antibiotic resistance, and treatment outcomes, etc.

RESULTForty-six cases (41.1%) were treated in division of hematology, 42 (37.5%) in neonatology, 9 (8.0%) in internal medicine, 8 (7.1%) in surgery, and 7 (6.3%) in pediatric intensive care unit. Sixty-five cases(58.0%) had underlying diseases. Fever was the most frequently presented symptom, as it was seen in 91 cases (81.3%); 52 cases(46.4%) had respiratory symptoms. Among these, 43 cases had pneumonia, 3 cases had respiratory failure, 3 cases were diagnosed as upper respiratory tract infection, 2 had pulmonary hemorrhage and 1 case had bronchitis. Twenty-six cases (23.2%)were diagnosed as severe sepsis and purulent meningitis separately, 14 cases(12.5%) had urinary tract infection. There were 73 (65.2%) strains inducing extended spectrum β-lactamases (ESBLs), of which 6 (8.2%) and 10 (13.7%) strains were resistant to amikacin and carbapenems respectively. Resistance rate against other antimicrobial agents varied from 64.6% to 100%.

OUTCOMES92 (82.1%) cases were cured or had improvement while 20 patients (17.9%) died or could not be cured at the end of treatment. Positive ESBLs (χ(2) = 6.609, P = 0.010), being complicated with severe sepsis (χ(2) = 40.253, P = 0.000) and requiring mechanical ventilation (χ(2) = 34.441, P = 0.000) indicate poor prognosis.

CONCLUSIONPatients with underlying diseases and newborns are susceptible to E. coli bloodstream infection. ESBLs infection, severe sepsis and mechanical ventilation indicate poor prognosis in E. coli blood stream infection. Clinicians may use carbapenems as empirical treatment for ESBLs infection. There may be carbapenem-resistant enterobacteriaceae strains infection if patients receiving treatment with carbapenems have no response.

Adolescent ; Bacteremia ; Carbapenems ; therapeutic use ; Child ; Child, Preschool ; Drug Resistance, Bacterial ; Escherichia coli ; drug effects ; Escherichia coli Infections ; blood ; drug therapy ; Female ; Humans ; Infant ; Infant, Newborn ; Male ; Meningitis, Bacterial ; Microbial Sensitivity Tests ; Pneumonia ; Urinary Tract Infections ; beta-Lactamases

A rare case of ventriculitis associated with the obstruction of aqueduct of Sylvius is reported and the pertinent literature reviewed. A 24 years old male, who had been suffering from a longstanding chronic pyogenic ear disease since childhood, was admitted to our clinic in Dec. 1973 with a comatose state. Contrast radiology showed the obstructive hydrocephalus with the occluded aqueduct of Sylvius, but neither intracerebral or intracerebellar space consuming mass presented. Cerebrospinal and ventricular fluid revealed a marked growth of Escherichia Coli. So ventriculitis complicating obstruction of the aqueduct of Sylvius due to chronic suppurative otitis media and mastoiditis was diagnosed in this patient, and treated by Torkildsen's operation with proper chemotherapy and resulted in good recovery. We experienced that ventriculitis initiated from meningitis might give rise to obstruction of the aqueduct of Sylvius and it could be considered as a brain abscess superimposed raised intracranial pressure from obstructive hydrocephalus.
Brain Abscess ; Cerebral Aqueduct* ; Coma ; Drug Therapy ; Ear Diseases ; Escherichia coli ; Humans ; Hydrocephalus ; Intracranial Pressure ; Male ; Mastoid ; Mastoiditis ; Meningitis ; Otitis Media, Suppurative ; Young Adult

A rare case of ventriculitis associated with the obstruction of aqueduct of Sylvius is reported and the pertinent literature reviewed. A 24 years old male, who had been suffering from a longstanding chronic pyogenic ear disease since childhood, was admitted to our clinic in Dec. 1973 with a comatose state. Contrast radiology showed the obstructive hydrocephalus with the occluded aqueduct of Sylvius, but neither intracerebral or intracerebellar space consuming mass presented. Cerebrospinal and ventricular fluid revealed a marked growth of Escherichia Coli. So ventriculitis complicating obstruction of the aqueduct of Sylvius due to chronic suppurative otitis media and mastoiditis was diagnosed in this patient, and treated by Torkildsen's operation with proper chemotherapy and resulted in good recovery. We experienced that ventriculitis initiated from meningitis might give rise to obstruction of the aqueduct of Sylvius and it could be considered as a brain abscess superimposed raised intracranial pressure from obstructive hydrocephalus.
Brain Abscess ; Cerebral Aqueduct* ; Coma ; Drug Therapy ; Ear Diseases ; Escherichia coli ; Humans ; Hydrocephalus ; Intracranial Pressure ; Male ; Mastoid ; Mastoiditis ; Meningitis ; Otitis Media, Suppurative ; Young Adult

OBJECTIVETo explore the neuro-protective effect and mechanism of qingkailing injection (QKL) against cerebral injury caused by E. coli-meningitis (CM).

METHODSThe CM model rabbits were treated by ampicillin with QKL as adjuvant. The leukocyte count and protein content in cerebral spinal fluid (CSF), the contents of water, sodium, potassium and calcium in cerebral tissues were measured before, 16 h and 26 h after Bacillus coli injection respectively. The expression of matrix metalloproteinase-9 (MMP-9) was determined at the same time.

RESULTSAdjunctive treatment with QKL can not only inhibit the increase of leukocyte cells, protein content in CSF, and water, sodium, calcium content in cerebral tissues, but also the decrease of potassium content revealed during simple antibiotic treatment. It also can decrease the expression of MMP-9 in cerebral tissues of rabbits with CM.

CONCLUSIONAs an adjunctive treatment, QKL can prevent transient inflammatory reaction and aggravation of brain injury in CM induced by simple antibiotic treatment, its mechanisms might relate with calcium antagonism and attenuation of MMP-9 expression in brain tissues.

Ampicillin ; therapeutic use ; Animals ; Anti-Bacterial Agents ; therapeutic use ; Brain ; metabolism ; Drug Therapy, Combination ; Drugs, Chinese Herbal ; therapeutic use ; Female ; Injections ; Male ; Matrix Metalloproteinase 9 ; biosynthesis ; Meningitis, Escherichia coli ; drug therapy ; Neuroprotective Agents ; therapeutic use ; Phytotherapy ; Rabbits

We evaluated the efficacy of non-competitive N-methyl-D-aspartate receptor antagonist MK-801 (dizocilpine) as an adjuvant therapy in experimental neonal bacterial meningitis. Meningitis was induced by injecting 10(6) colony forming units of Escherichia coli into the cisterna magna. MK-801 3 mg/kg was given as a bolus intravenous injection, 30 min before the induction of meningitis. MK-801 did not down-modulate the inflammatory parameters, such as increased intracranial pressure, cerebrospinal fluid (CSF) leukocytosis, increased lactate and TNF-alpha levels in the CSF, and hypoglycorrhachia observed in the meningitis group. MK-801 did not significantly attenuate the elevated glutamate concentration in the CSF. However, MK-801 showed some neuroprotective effects as evidenced by significant attenuation of cerebral lipid peroxidation products (conjugated dienes) and increase of brain high-energy phosphate compounds (ATP and PCr). Improvement in cerebral cortical cell membrane Na+, K+ -ATPase activity did not reach a statistical significance. These results suggest that MK-801 was effective in ameliorating brain injury in neonatal bacterial meningitis, although it failed to attenuate the inflammatory responses.
Animals ; Animals, Newborn ; Blood Glucose/metabolism ; Brain/cytology ; Brain/drug effects* ; Brain/metabolism ; Cell Membrane/drug effects* ; Cell Membrane/metabolism ; Cerebral Cortex/metabolism ; Dizocilpine Maleate/pharmacology* ; Energy Metabolism* ; Excitatory Amino Acid Antagonists/pharmacology ; Glutamic Acid/cerebrospinal fluid ; Lactic Acid/blood ; Leukocytes/metabolism ; Meningitis, Escherichia coli/drug therapy ; Meningitis, Escherichia coli/metabolism* ; Neurons/drug effects* ; Neurons/metabolism ; Neuroprotective Agents/pharmacology* ; Random Allocation ; Swine ; Tumor Necrosis Factor/cerebrospinal fluid

We sought to know whether hypertonic (7%) saline (HTS) attenuates brain injury by improving cerebral perfusion pressure (CPP) and down-modulating acute inflammatory responses in experimental bacterial meningitis in the newborn piglet. Twenty-five newborn piglets were assorted into three groups: 6 in the control group (C), 10 in the meningitis group (M), and 9 in the meningitis with HTS infusion group (H). Meningitis was induced by intracisternal injection of 10(8) colony forming units of Escherichia coli in 100 microliter of saline. 10 mL/kg of HTS was given intravenously as a bolus 6 hr after induction of meningitis, thereafter the infusion rate was adjusted to maintain the serum sodium level between 150 and 160 mEq/L. HTS significantly attenuated meningitis-induced brain cell membrane disintegration and dysfunction, as indicated by increased lipid peroxidation products and decreased Na+, K+-ATPase activity in the cerebral cortex in M. HTS significantly attenuated acute inflammatory markers such as increased intracranial pressure, elevated lactate level and pleocytosis in the cerebrospinal fluid observed in M. Reduced CPP observed in M was also significantly improved with HTS infusion. These findings implicate some attenuation of the meningitis-induced alterations in cerebral cortical cell membrane structure and function with HTS, possibly by improving CPP and attenuating acute inflammatory responses.
Animals ; Animals, Newborn ; Anti-Inflammatory Agents/administration and dosage ; Brain Diseases/*drug therapy/*pathology ; Cerebral Cortex/*drug effects/*pathology ; Disease Models, Animal ; Intracranial Pressure/drug effects ; Meningitis, Escherichia coli/complications/*drug therapy/*pathology ; Research Support, Non-U.S. Gov't ; Saline Solution, Hypertonic/*administration and dosage ; Swine ; Treatment Outcome

After antibiotic prophylaxis with metronidazole and levofloxacin, a transrectal sextant biopsy was performed under the guide of transrectal ultrasonography (TRUS) for a 75-year-old suspicious patient with prostate adenocarcinoma. Although antibiotics were also given after this procedure, the patient still developed fever, anxious, agrypnia and headache. Blood cultures remained negative. Lumbar puncture was performed and was consistent with Escherichia coli bacterial meningitis.
Adenocarcinoma ; pathology ; Aged ; Anti-Infective Agents ; administration & dosage ; Anti-Infective Agents, Urinary ; administration & dosage ; Biopsy ; adverse effects ; Escherichia coli Infections ; drug therapy ; etiology ; Humans ; Levofloxacin ; Male ; Meningitis ; etiology ; microbiology ; prevention & control ; Metronidazole ; administration & dosage ; Ofloxacin ; administration & dosage ; Prostatic Neoplasms ; pathology ; Ultrasound, High-Intensity Focused, Transrectal