Infection and Drug Resistance (Oct 2023)
A Multicenter Epidemiological and Pathogenic Characteristics Study of Community-Acquired Bacterial Meningitis Children in China: Results from the Chinese Pediatric Bacterial Meningitis Surveillance (CPBMS) 2019–2020
Abstract
Caiyun Wang,1 Hongmei Xu,2 Gang Liu,3,4 Jing Liu,5 Hui Yu,6 Biquan Chen,7 Guo Zheng,8 Min Shu,9 Lijun Du,10 Zhiwei Xu,11 Lisu Huang,1,12 Haibo Li,13 Sainan Shu,14 Yinghu Chen,1 Corporate Authors of Chinese Pediatric Bacterial Meningitis Surveillance (CPBMS) Study Group:Dong Wang, Huiling Deng, Songting Bai, Qingwen Shan, Chunhui Zhu, Jianmei Tian, Jianhua Hao, Aiwei Lin, Daojiong Lin, Jinzhun Wu, Xinhua Zhang, Qing Cao, Zhongbin Tao, Yuan Chen, Guolong Zhu, Ping Xue, Zhengzhen Tang, Xuewen Su, Zhenghai Qu, Shiyong Zhao, Lin Pang On behalf of The CPBMS Study Group1Department of Infectious Disease, Children’s Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, National Children’s Regional Medical Center, Hangzhou, Zhejiang, People’s Republic of China; 2Department of Infectious Disease, Children’s Hospital of Chongqing Medical University, Chongqing, People’s Republic of China; 3Department of Infectious Diseases, Key Laboratory of Major Diseases in Children, Ministry of Education, Beijing Children’s Hospital, Capital Medical University, National Center for Children’s Health, Beijing, People’s Republic of China; 4Research Unit of Critical Infection in Children, Chinese Academy of Medical Sciences, Beijing, People’s Republic of China; 5Department of Infectious Disease, Hunan Children’s Hospital, Changsha, Hunan, People’s Republic of China; 6Department of Infectious Disease, The Children’s Hospital of Fudan University, Shanghai, People’s Republic of China; 7Department of Infection, Anhui Province Children’s Hospital, Hefei, Anhui, People’s Republic of China; 8Department of Neurology, Children’s Hospital of Nanjing Medical University, Nanjing, Jiangsu, People’s Republic of China; 9Department of Pediatrics, West China Second University Hospital, Sichuan University/ West China Women’s and Children’s Hospital, Chengdu, Sichuang, People’s Republic of China; 10Department of Neurology, Children’s Hospital of Shanxi, Taiyuan, Shanxi, People’s Republic of China; 11Pediatric Inpatient Ward, The 2nd Affiliated Hospital and Yuying Children’s Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, People’s Republic of China; 12Department of Infectious Disease, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, People’s Republic of China; 13Outpatient Department of Pediatrics, The First Hospital of Jilin University, Changchun, Jilin, People’s Republic of China; 14Department of Pediatric Infection and Gastroenterology, Tongji Hospital, Tongji Medical College of Huazhong University of Science and Technology, Wuhan, Hubei, People’s Republic of China; The CPBMS team: the Children’s Hospital of Zhejiang University School of Medicine; National Clinical Research Center for Child Health; National Children’s Regional Medical Center; Children’s Hospital of Chongqing Medical University; Beijing Children’s Hospital; Capital Medical University; National Center for Children’s Health; Research Unit of Critical Infection in Children; Chinese Academy of Medical Sciences, 2019RU016; Hunan Children’s Hospital; the Children’s Hospital of Fudan University; Anhui Province Children’s Hospital; Children’s Hospital of Nanjing Medical University; West China Second University Hospital; Sichuan University/ West China Women’s and Children’s Hospital; Shanxi Children’s Hospital; the 2nd Affiliated Hospital and Yuying Children’s Hospital of Wenzhou Medical University; Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine; the First Hospital of Jilin University; the Affiliated Children’s Hospital of Xi’an Jiaotong University; Xi’an Central Hospital; the First Affiliated Hospital of Zhengzhou University; the First Affiliated Hospital of Guangxi Medical University; Jiangxi Provincial Children’s Hospital; Children’s Hospital of Soochow University; Kaifeng Children’s Hospital; Children’s Hospital Affiliated to Shandong University; Hainan Women and Children’s medical center; Women and Children’s Hospital; School of Medicine; Xiamen University; Shanghai Children’s Medical Center; National Children’s Medical Center; Shanghai Jiaotong University School of Medicine; the First Hospital of Lanzhou University; the Second Hospital of Hebei Medical University; the Women’s and Children’s Hospital of Qinghai Province; Taiyuan Maternal and Child Health Care Hospital; the First People’s Hospital of Zunyi; Inner Mongolia People’s Hospital; the Affiliated Hospital of Qingdao University; Hangzhou Children’s Hospital; Beijing Ditan Hospital; Capital Medical University; Tongji Hospital; Tongji Medical College of Huazhong University of Science and TechnologyCorrespondence: Yinghu Chen, Department of Infectious Disease, Children’s Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, National Children’s Regional Medical Center, 3333 Binsheng Road, Hangzhou, Zhejiang, 310052, People’s Republic of China, Tel +86 13857154891, Email [email protected]: To explore the epidemiological and pathogenic characteristics of children with community-acquired bacterial meningitis.Methods: A multicenter, retrospective study was conducted among CABM patients under 15 years old from 33 hospitals in China from 2019 to 2020. The medical record, laboratory, and microbiological data were collected and analyzed.Results: A total of 1610 children with CABM were identified and presented at a median onset age of 45 days of whom 955 (59.3%) were males. CABM occurred mostly in infants 3 months old cases. About 9.7% (19/195) strains of E. coli produced ultra‑broad‑spectrum β‑lactamases. The common intracranial imaging complications were subdural effusion and (or) empyema in 349 (21.7%), hydrocephalus in 233 (14.5%), and cerebral abscess in 178 (11.1%). A total of 389 (24.2%) cases were completely cured and 1088 (67.6%) cases improved. Among 166 patients (10.3%) with adverse outcomes, 32 cases (2.0%) died, and 37 cases (2.3%) relapsed.Conclusion: The onset age of CABM in children is usually within 1 year of age, especially < 3 months. The primary pathogens in infants less than 3 months old are E. coli and GBS, and the dominant pathogen in children older than 3 months old is S. pneumoniae. Subdural effusion and (or) empyema and hydrocephalus are common complications. CABM should not be excluded even if CSF leukocyte counts are within normal range. Due to the low detection rate of pathogens in children with CABM, standardized CSF bacteriological examination should be paid more attention to increase the pathogen detection rate. Non‑culture CSF detection methods may facilitate pathogenic diagnosis.Keywords: meningitis, bacterial, pathogen, childhood, diagnosis, outcome
