Etiology of community-acquired bacterial meningitis in children at a tertiary-care centre in Montreal, Canada.

IF 1.8 4区 医学 Q2 PEDIATRICS
Paediatrics & child health Pub Date : 2024-10-20 eCollection Date: 2025-05-01 DOI:10.1093/pch/pxae057
Anne-Sophie Besner, Christian Renaud, Jocelyn Gravel
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引用次数: 0

Abstract

Objectives: This study aimed to identify the bacteria responsible for community-acquired bacterial meningitis in infants and children.

Methods: This was a retrospective cohort study including children aged 1 day to 18 years with confirmed bacterial meningitis, evaluated at a tertiary-care, Canadian emergency department between 2014 and 2022. The primary outcome was the pathogen identified. Other variables of interest were complications, age, and diagnostic method. Medical charts were reviewed by a co-investigator and 25% were assessed in duplicate.

Results: All 79 eligible cases were included. The main causal agents were Group B Streptococcus (GBS) (n = 20; 25%), Streptococcus pneumoniae (n = 16; 20%), Neisseria meningitidis (n = 16; 20%), and Haemophilus influenzae (n = 9; 11%). Etiology exhibited age-dependent variations, with 85% of GBS and 100% of Escherichia coli infections in children under 2 months. All pneumococcal and Group A Streptococcus cases were in children older than 6 months. All children infected by S. pneumoniae were vaccinated but the serotype was not covered by vaccination in 7/8 infections. All children with N. meningitidis were either too young to be vaccinated (n = 10) or infected by a serotype not covered by the given vaccine. Fifty-five bacteria were identified by cerebrospinal fluid culture, 17 by Polymerase Chain Reaction (PCR), and 7 by both methods.

Conclusion: GBS is now the leading etiology of paediatric community-acquired bacterial meningitis at our centre. The etiology of bacterial meningitis varies greatly by age. Future studies should focus on improving the serotype spectrum of vaccines, identifying strategies to lower GBS infection, and improving the use of PCR as a diagnostic tool.

加拿大蒙特利尔一家三级保健中心儿童社区获得性细菌性脑膜炎的病因学
目的:本研究旨在鉴定导致婴幼儿社区获得性细菌性脑膜炎的细菌。方法:这是一项回顾性队列研究,纳入了2014年至2022年间在加拿大三级保健急诊科评估的1天至18岁确诊细菌性脑膜炎的儿童。主要结果是确定病原体。其他感兴趣的变量包括并发症、年龄和诊断方法。医学图表由一名共同研究者审阅,25%的病历一式两份评估。结果:79例符合条件的病例全部纳入。主要病原为B群链球菌(GBS) (n = 20;25%),肺炎链球菌(n = 16;20%),脑膜炎奈瑟菌(n = 16;20%)和流感嗜血杆菌(n = 9;11%)。病因学表现出年龄依赖性差异,在2个月以下的儿童中,85%的GBS和100%的大肠杆菌感染。所有肺炎球菌和A群链球菌病例均发生在6个月以上的儿童中。所有感染肺炎链球菌的儿童均接种了疫苗,但7/8的感染未包括血清型。所有感染脑膜炎奈瑟菌的儿童要么年龄太小,不能接种疫苗(n = 10),要么感染的血清型未被接种疫苗覆盖。脑脊液培养法鉴定细菌55种,聚合酶链反应法鉴定细菌17种,两种方法联合鉴定细菌7种。结论:GBS目前是我们中心儿童社区获得性细菌性脑膜炎的主要病因。细菌性脑膜炎的病因因年龄而异。未来的研究应侧重于改进疫苗的血清型谱,确定降低GBS感染的策略,以及改进PCR作为诊断工具的使用。
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来源期刊
Paediatrics & child health
Paediatrics & child health 医学-小儿科
CiteScore
2.10
自引率
5.30%
发文量
208
审稿时长
>12 weeks
期刊介绍: Paediatrics & Child Health (PCH) is the official journal of the Canadian Paediatric Society, and the only peer-reviewed paediatric journal in Canada. Its mission is to advocate for the health and well-being of all Canadian children and youth and to educate child and youth health professionals across the country. PCH reaches 8,000 paediatricians, family physicians and other child and youth health professionals, as well as ministers and officials in various levels of government who are involved with child and youth health policy in Canada.
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