Clinical features of neonatal purulent meningitis caused by different pathogens

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 Gram-negative 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 χ2 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 3 100 (2 600, 3 380) 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 Gram-positive 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. Key words: Meningitis, bacterial; Gram-positive bacteria; Gram-negative bacteria; Clinical features