Epidemiology of Meningitis in Canadian Neonatal Intensive Care Units
Epidemiology of Meningitis in Canadian Neonatal Intensive Care Units
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DOI：
10.1097/inf.0000000000002247
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发表时间：
2019-05-01
影响因子：
3.6
通讯作者：
Shah, Prakesh S.
中科院分区：
文献类型：
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作者：
El-Naggar, Walid;Afifi, Jehier;Shah, Prakesh S.
背景：脑膜炎是一种严重的疾病，在新生儿时期比在任何其他年龄组更常见。需要来自大型国家队列的最新数据来确定新生儿脑膜炎（NM）的流行病学是否发生了变化。目的：评估加拿大新生儿重症监护病房（NICUs） NM的发生率、致病微生物、危险因素、时间趋势和短期结局。方法：回顾性分析2010年1月至2016年12月加入加拿大新生儿网络的新生儿重症监护病房。对脑膜炎患者进行回顾。将脑膜炎患者的结局与1:2匹配（妊娠期、性别和出生体重）的无脑膜炎新生儿进行比较。结果：在7年的研究期间，新生儿重症监护病房入院患者中，新生儿脑膜炎的发生率在2.2 - 3.5/ 1000之间，大多数患者（87%）为晚发性脑膜炎（出生后3天）。早发性和晚发性脑膜炎最常见的细菌是大肠杆菌，其次是B群链球菌。只有31%（95%可信区间（CI）： 24.06-38.63）的脑膜炎新生儿同时出现菌血症。NM与癫痫发作增加有关[优势比（OR）： 8.63；95% CI: 4.73-15.7]、早产儿视网膜病变（OR: 3.23; 95% CI: 1.30-8.02）、支气管肺发育不良（OR: 1.93; 95% CI: 1.11-3.35）、机械通气天数（OR: 1.03; 95% CI: 1.02-1.04）和住院时间（OR: 1.02; 95% CI: 1.01-1.02），但与出院前死亡率无关（OR: 1.29; 95% CI: 0.74-2.23）。结论：加拿大新生儿重症监护病房的NM发生率基本保持不变。NM与主要发病率增加和住院时间延长有关，但与出院前死亡率无关。
Background: Meningitis is a serious disease that occurs more commonly in the neonatal period than in any other age group. Recent data from large national cohorts are needed to determine if the epidemiology of neonatal meningitis (NM) has changed. Aim: To assess the rates, causative organisms, risk factors, temporal trends and short-term outcomes of NM in Canadian Neonatal Intensive Care Units (NICUs).Methods: A retrospective review of newborn infants admitted to NICUs participating in the Canadian Neonatal Network between January 2010 and December 2016. Patients with meningitis were reviewed. Outcomes of patients with meningitis were compared with 1: 2 matched (for gestation, sex and birth weight) neonates without meningitis.Results: Rates of NM ranged between 2.2 and 3.5/ 1000 NICU admissions during the 7-year study period with the majority of patients (87%) having late-onset meningitis (at > 3 days after birth). The most common bacterial organism for both early-and late-onset meningitis was -Escherichia coli followed by group B streptococci. Only 31% [95% confidence interval (CI): 24.06-38.63) of neonates with meningitis had simultaneous bacteremia. NM was associated with increased seizures [odds ratio (OR): 8.63; 95% CI: 4.73-15.7], retinopathy of prematurity (OR: 3.23; 95% CI: 1.30-8.02), bronchopulmonary dysplasia (OR: 1.93; 95% CI: 1.11-3.35), days of mechanical ventilation (OR: 1.03; 95% CI: 1.02-1.04) and length of hospital stay (OR: 1.02; 95% CI: 1.01-1.02), but not with mortality before discharge (OR: 1.29; 95% CI: 0.74-2.23).Conclusions: The rate of NM remains largely unchanged in Canadian NICUs. NM was associated with increased major morbidities and longer hospital stay but not with mortality before discharge.