J Gaschignard1, C Levy, E Bingen, R Cohen. 1. Service de Pédiatrie générale, Université Paris Didérot, hôpital Robert Debré, 48, boulevard Serrurier, 75019 Paris, France. jean.gaschignard@inserm.fr
Abstract
BACKGROUND: Neonatal bacterial meningitis has a mortality rate over 10 % and induces neurological sequellae in 20 to 50 % of cases. Escherichia coli (E. coli) is the second cause behind Group B streptococcus (GBS). The clinical and epidemiological features of neonatal meningitis due to E. coli between 2001 and 2010 with the data from the National Observatory are presented here. METHODS: Cases of child meningitis were prospectively collected since 2001 by a network of 252 pediatric wards associated with 166 microbiology laboratories. Risk factors, clinical signs, cerebrospinal fluid analysis, treatment and mortality were collected. RESULTS: 638 cases of neonatal bacterial meningitis were reported by 114 pediatric wards, among which 28 % (n=180) due to E. coli. If GBS prevailed in early and late-onset forms in term infants (84 % and 57 % for GBS vs 13 % and 28 % for E. coli), E. coli prevailed in preterm infants (42 % vs 37 % for GBS), and this trend increased in very preterm (GA < 33) (53 % vs 18 %). Number of E. coli early and late-onset meningitis didn't significantly vary over time. Antibiotherapy most often associated a 3(rd) generation cephalosporin, an aminosid and ciprofloxacin; sterilisation of the cerebrospinal fluid was achieved within day 2 to day 4 in 84 % of newborns. Only 3 strains were ESBL. Mortality was 11 % with E. coli, comparable to GBS (12 %) but reached 15 % in preterm infants. CONCLUSIONS: E. coli was the prevailing cause of early and late onset bacterial meningitis in premature infants, associated with a higher mortality than in term infants.
BACKGROUND:Neonatal bacterial meningitis has a mortality rate over 10 % and induces neurological sequellae in 20 to 50 % of cases. Escherichia coli (E. coli) is the second cause behind Group B streptococcus (GBS). The clinical and epidemiological features of neonatal meningitis due to E. coli between 2001 and 2010 with the data from the National Observatory are presented here. METHODS: Cases of childmeningitis were prospectively collected since 2001 by a network of 252 pediatric wards associated with 166 microbiology laboratories. Risk factors, clinical signs, cerebrospinal fluid analysis, treatment and mortality were collected. RESULTS: 638 cases of neonatal bacterial meningitis were reported by 114 pediatric wards, among which 28 % (n=180) due to E. coli. If GBS prevailed in early and late-onset forms in term infants (84 % and 57 % for GBS vs 13 % and 28 % for E. coli), E. coli prevailed in preterm infants (42 % vs 37 % for GBS), and this trend increased in very preterm (GA < 33) (53 % vs 18 %). Number of E. coli early and late-onset meningitis didn't significantly vary over time. Antibiotherapy most often associated a 3(rd) generation cephalosporin, an aminosid and ciprofloxacin; sterilisation of the cerebrospinal fluid was achieved within day 2 to day 4 in 84 % of newborns. Only 3 strains were ESBL. Mortality was 11 % with E. coli, comparable to GBS (12 %) but reached 15 % in preterm infants. CONCLUSIONS:E. coli was the prevailing cause of early and late onset bacterial meningitis in premature infants, associated with a higher mortality than in term infants.