Objective To analyze the clinical features of neonatal purulent meningitis (NPM caused by Gram-positive and Gram-negative bacteria.Method From January 2008 to December,2015,the clinical data of NPM with positive cerebrospinal-fluid (CSF) culture admitted to Children's Hospital of Fudan University were reviewed retrospectively.Patients were assigned into Gram-positive group and Gramnegative group according to CSF culture,and general information,clinical presentation,laboratory examination and outcome were compared between the two groups.Wilcoxon Rank-Sum test was used to compare means.Proportions were compared using x2 test.Result A total of 82 NPM patients with positive CSF culture were enrolled in the study,and 44 (53.7％) were male.The average gestational age was 38.5 (35.6,39.6) weeks and the mean birth weight was 3100 (2600,3380) grams.16 (19.5％) cases were early-onset meningitis and 66 (80.5％) were late-onset.In 82 cases,43 (52.4％) showed Gram-positive bacteria and 39 (47.6％) Gram-negative in CSF culture.The five most common pathogens were escherichia coli (22 cases,26.8％),group B streptococcus (GBS) (10 cases,12.2％),enterococcus faecium (8 cases,9.8％),coagulase-negative staphylococcus(8 cases,9.8％) and klebsiella pneumoniae (5 cases,6.1％).In early-onset patients,the main causative pathogens isolated from CSF were GBS (3 cases,18.8％) and enterococcus (3 cases,18.8％).Escherichia coli (20 cases,30.3％) and coagulase-negative staphylococcus (8 cases,12.1％) were the most common pathogens in late-onset patients.Gram-positive group and Gram-negative group had similar clinical presentation (P ＞ 0.05).The ratio of patients with blood C-reactive protein ＞ 8 mg/L in Gram-negative group was higher than that in Grampositive group (P ＜ 0.05).Those with Gram-negative bacterial meningitis had a higher incidence of hydrocephalus than Gram-positive (P ＜ 0.05).Conclusion The main pathogens of NPM are escherichia coli and GBS.Neonates with Gram-positive bacteria meningitis have similar clinical presentation with those with Gram-negative meningitis,but have different laboratory examination and complication characteristics.%目的 探讨不同病原所致新生儿化脓性脑膜炎患儿的临床特点.方法 选取2008年1月至2015年12月复旦大学附属儿科医院收治的确诊新生儿化脓性脑膜炎患儿资料进行回顾性分析,根据脑脊液培养结果分为G+菌组和G-菌组,分析患儿一般资料、临床表现、实验室检查结果及临床转归情况,采用秩和检验、x2检验比较两组间差异.结果共纳入化脓性脑膜炎且脑脊液培养阳性患儿82例,其中男44例,占53.7％.胎龄38.5(35.6,39.6)周,出生体重3 100(2 600,3 380)g.G+菌组43例(52.4％),G-菌组39例(47.6％).早发型感染16例(19.5％),晚发型感染66例(80.5％).脑脊液主要致病菌为大肠埃希菌22例(26.8％),B族溶血链球菌(group B streptococcus,GBS) 10例(12.2％),屎肠球菌8例(9.8％),凝固酶阴性葡萄球菌8例(9.8％),肺炎克雷伯菌5例(6.1％).早发型感染脑脊液主要细菌为GBS和屎肠球菌各3例(18.8％),晚发型感染脑脊液主要细菌为大肠埃希菌20例(30.3％)和凝固酶阴性葡萄球菌8例(12.1％).G+菌组C反应蛋白＞8 mg/L比例及脑积水发生率明显低于G-菌组(53.5％比82.1％,16.3％比41.0％),差异有统计学意义(P＜0.05).两组患儿临床表现差异无统计学意义(P＞0.05).结论新生儿化脓性脑膜炎主要致病菌以大肠埃希菌和GBS为主,G+菌和G-菌感染患儿临床表现相似,但实验室检查及并发症特点不同.
展开▼
