儿童解没食子酸链球菌脑膜炎系统评价

Streptococcus gallolyticus meningitis:A systematic review

背景国内外儿童解没食子酸链球菌(SG)所致脑膜炎报道较少,临床特点尚不明确。目的 系统评价儿童SG脑膜炎的临床特点。设计系统评价。方法 系统检索PubMed、Embase、Web of Science、中国知网、万方和维普数据库中儿童SG脑膜炎的相关文献,检索时间均为建库至2022年11月9日。纳入报道儿童SG感染且致细菌性脑膜炎的病例报告文献;排除综述、会议论文、仅有摘要不能获取全文的文献、全文非中文和英文的文献。由2位评价员独立筛选文献、提取资料,按照病例报告及病例系列报告质量评价工具表对纳入的文献进行质量评价,提取文献特征、病例临床特征、实验室指标和SG药敏结果。主要结局指标存活率和并发症。结果17篇文献中的21例SG婴幼儿纳入本文分析,男16例,女4例,1例未报告性别;3例早产儿,16例足月儿,2例未报告胎龄;发病日龄(14.5±16.6)d;发热14例;神经系统异常17例,有消化道症状9例,有呼吸系统症状9例,心动过速3例。11例报告了CRP检测结果均升高;9例外周血WBC<4×10^(9)·L^(-1),6例>10×10^(9)·L^(-1)。CSF中的WBC计数均升高;18例报告了CSF糖水平,14例<2.2 mmol·L^(-1);17例报告了CSF蛋白水平,15例>1700 mg·L^(-1)。21例CSF培养中20例阳性,18例血培养中16例阳性,5例尿培养中1例阳性,1例粪培养阳性;SG巴氏亚种17例,SG解没食子酸亚种2例,SG 2例。12例单用1种抗生素(11例SG菌株对青霉素/氨苄西林均敏感,1例未报告),9例联用2种抗生素(8例SG菌株对青霉素/氨苄西林敏感,1例耐药),最短抗生素使用时间14 d。6例描述有并发症,其中并发脑室出血和脑室炎各2例,1例合并脑积水、脑室扩张、神经运动迟缓、自主运动不良和肌张力增高,1例同时并发双侧视觉诱发电位下降、硬膜下积液、癫。结论SG脑膜炎的发病人群主要为2月龄以下小婴儿,可选择青霉素类药物或头孢噻肟治疗,临床转归大多良好。

Background There are few cases of children's meningitis caused by Streptococcus gallolytica(SG)at home and abroad,and the overall clinical characteristics are still unclear.Objective To systematically review the clinical features of SG meningitis.Design Systematic review.Methods PubMed,Embase,Web of Science,CNKI,Wanfang,and VIP databases were searched for literature related to SG meningitis from the inception to November 9,2022.Cases of bacterial meningitis infected by SG in children were included.Publication types of review and conference papers were excluded.The literature unable to get the full text or writing in other languages except Chinese and English was also excluded.Two investigators independently reviewed the literature,extracted literature features,clinical characteristics of cases,laboratory indexes,and antibiotic susceptibility of SG,and assessed the quality of the included literature.Main outcome measures Survival rate and complications.Results A total of 21 subjects from 17 literature were included in this systematic review,including 16 males,4 females,and 1 case without reported gender.There were 3 premature infants,16 full-term infants,and 2 cases without reported gestational age.The age of onset was(14.5±16.6)d.There were 14 cases with fever,17 cases with neurologic abnormality,9 cases with gastrointestinal signs,9 cases with respiratory symptoms,and 3 cases with tachycardia.CRP level increased in all 11 reported cases.Nine cases showed peripheral WBC counts below 4×10^(9)·L^(-1)and 6 cases had peripheral WBC counts above 10×10^(9)·L^(-1).CSF leukocyte counts increased in all patients.Eighteen cases reported CSF glucose level with 14 cases below 2.2 mmol·L^(-1),and 17 cases reported CSF protein concentration with 15 cases above 1700 mg·L^(-1).Twenty cases were positive in 21 cases of CSF culture,16 cases were positive in 18 cases of blood culture,1 case was positive in 5 cases of urine culture,and 1 case was positive fecal culture.SGSP was found in 17 cases,SGSG in 2 cases,and SG in 2 cases.Twelve cases were treated with monotherapy(strains of 11 cases were susceptible to penicillin/ampicillin,1 case was not reported),9 cases were treated with 2 antibacterial agents(strains in 8 cases were susceptible to penicillin/ampicillin,strains in 1 case was resistant),and the course of antibacterial agents was at least 14 days.Complications were reported in 6 cases,including 2 cases with ventricular hemorrhage,2 cases with ventriculitis,1 case with hydrocephalus,ventricular dilation,neuromotor delay,poor spontaneous motor mobilization,and hypertonia of the limbs,and 1 case with bilateral reduction in visual evoked potentials,subdural effusion,and seizure.Conclusion SG meningitis mainly occurred in infants under 2 months.Penicillins or cefotaxime could be selected for treatment and had good clinical outcomes.