早产儿与足月儿细菌性脑膜炎的临床特点、病原菌分布及转归分析

Clinical characteristics,pathogen distributions and outcomes of bacterial meningitis in preterm and term infants

目的探讨和比较早产儿与足月儿细菌性脑膜炎的临床特点、病原菌分布及转归。方法回顾性分析2013年1月至2018年12月在广州市妇女儿童医疗中心住院的252例新生儿细菌性脑膜炎的病例资料,根据胎龄分为早产儿组64例和足月儿组188例,比较两组患儿的临床表现、实验室检查、病原菌分布及临床转归。结果两组患儿首发临床表现均以发热最常见,但早产儿组嗜睡、呼吸暂停、喂养不耐受发生率均明显高于足月儿组(P<0.05)。首次血液/脑脊液异常率比较两组差异无统计学意义(P>0.05)。合并感染均以败血症为主,并发症主要为硬膜下积液和脑积水,早产儿脑膜炎并发症发生率为60.9%(39/64),明显高于足月儿的44.7%(84/188),差异有统计学意义(P<0.05)。早产儿组病原菌以大肠埃希菌、无乳链球菌多见,足月儿组以肺炎克雷伯菌、无乳链球菌多见。两组患儿阳性菌转阴时间比较差异无统计学意义,但早产儿组抗生素疗程明显长于足月儿组(P<0.05)。两组患儿的临床治愈/好转率约为95%,两者比较差异无统计学意义。结论早产儿细菌性脑膜炎早期临床表现不典型,相对容易漏诊,并发症发生率明显高于足月儿,抗生素使用时间更长,但早期、合理规范治疗后其临床治愈/好转率并不差于足月儿。

Objective To investigate and compare the clinical characteristics,pathogen distributions and outcomes of bacterial meningitis in preterm and term infants.Methods The data of 252 cases of neonatal bacterial meningitis hospitalized in Guangzhou Women and Children′s Medical Center from January 2013 to December 2018 were retrospectively analyzed and divided into two groups according to gestational age:preterm group(n=64)and term group(n=188).The clinical manifestations,laboratory examinations,pathogen distributions and clinical outcomes of the children in two groups were compared.Results Fever was the most common clinical manifestation in both groups,but the incidences of lethargy,apnea and feeding intolerance in preterm group were significantly higher than those in term group(P<0.05).There was no significant difference in the rate of the first hemogram/cerebrospinal fluid abnormality between two groups(P>0.05).Sepsis,subdural effusion and hydrocephalus were the main complications in both groups.The incidence of complications in premature infants was 60.9%(39/64),which was significantly higher than that in full-term infants(44.7%,84/188),with a statistically significant difference(P<0.05).Escherichia coli and Streptococcus agalactiae were the most common pathogens in the preterm infants,whereas Klebsiella pneumoniae and Streptococcus agalactiae were the most common pathogens in the term infants.There was no statistical difference in the time of positive bacteria turning negative between two groups,but the course of antibiotics in preterm group was significantly longer than that in term group(P<0.05).The clinical cure/improvement rates in the two groups was about 95%,and the difference between two groups was not statistically significant(P>0.05).Conclusion Early clinical manifestations of bacterial meningitis in preterm infants are atypical and relatively easy to be missed.The incidence of complications is significantly higher than that of full-term infants,and the duration of antibiotic use is longer.However,the clinical cure/improvement rate of premature infants is not worse than that of full-term infants after reasonable and standardized early treatment.