Clinical features of Escherichia coli meningitis in infants and risk factors for its complications
LU Chenggang1, ZHU Mengquan2, ZHANG Jiening3, GE Hejia4, FANG Sheng5, LI Junsheng6, XU Huiqing7, XU Zhiwei2, CHEN Lihua8, ZHENG Jishan7, CHEN Yinghu1
1.Department of Infectious Diseases, Children’s Hospital of Zhejiang University School of Medicine, Hangzhou 310052, China; 2.Department of General Pediatrics, the Second Affiliated Hospital & Yuying Children’s Hospital of Wenzhou Medical University, Wenzhou 325027, China; 3.Department of Pediatrics, Jiaxing Maternity and Child Health Care Hospital, Jiaxing 314050, China; 4.Department of Pediatrics, Jiaxing Second Hospital, Jiaxing 314001, China; 5.Department of Pediatric Internal Medicine, Taizhou Hospital Affiliated to Wenzhou Medical University, Taizhou 317000, China; 6.Department of Neonatology, Lishui Maternal and Child Health Hospital, Lishui 323000, China; 7.Department of Pediatrics, Ningbo Women and Children’s Hospital, Ningbo 315012, China; 8.Department of Neonatology, Children’s Hospital of Zhejiang University School of Medicine, Hangzhou 310052, China
LU Chenggang1,ZHU Mengquan2,ZHANG Jiening3, et al. Clinical features of Escherichia coli meningitis in infants and risk factors for its complications[J]. JOURNAL OF WEZHOU MEDICAL UNIVERSITY, 2023, 53(8): 621-627.
Abstract：Objective: To analyze the clinical characteristics and risk factors for complications of Escherichia coli meningitis in infants, and to provide evidence-based reference for its diagnosis, treatment and improvement of prognosis. Methods: The clinical data of 918 children with community-acquired bacterial meningitis admitted into 52 hospitals in Zhejiang Province from January 1, 2019 to April 30, 2021 were collected. A total of 62 children with bacterial meningitis whose cerebrospinal fluid and (or) blood culture was positive for Escherichia coli were selected. The clinical characteristics, drug sensitivity of isolated strains and risk factors for complications were retrospectively analyzed. Results: Of 62 patients who were aged 1-228 days, 43 cases≤28 days (69.4%), 16 cases >28 days≤3 months (25.8%), and 3 cases >3 months (4.8%); 23 cases (37.1%) had underlying diseases. All patients had fever, with 15 cases (24.2%) having fever for more than 1 week. The initial extracranial infectious diseases were sepsis (47 cases, 75.81%), gastrointestinal infection (20 cases, 32.3%), and respiratory tract infection (14 cases, 22.6%). Complications occurred in 40 cases (64.5%), with subdural fluid/pus accumulation being the most common (19 cases, 30.6%). Univariate analysis showed that the age, first cerebrospinal fluid white blood cell count and micro total protein content of children with complications were higher than those without complications, with significant difference (P<0.05). Multivariate Logistic regression analysis showed that age >28 days (OR=5.730, 95%CI=1.216-27.001, P<0.05) and first cerebrospinal fluid micro total protein >1 271.5 mg/L (OR=5.473, 95%CI=1.473-20.329, P<0.05) were risk factors for complications in children with Escherichia coli meningitis. Escherichia coli was highly resistant to ampicillin (55.0%) and amoxicillin (55.6%), moderately resistant to cefuroxime, ceftriaxone and cefotaxime, and completely sensitive to meropenem, imipenem and ertapenem. Conclusion: Escherichia coli meningitis mainly occurs in infants younger than 3 months old, with a high incidence of complications. Age >28 days and first cerebrospinal fluid micro total protein >1 271.5 mg/L are important risk factors for complications. Clinicians should use effective antibacterial drugs and detect complications as early as possible, and implement early intervention to improve prognosis.
