Bacterial Meningitis in Children Oregon Health （细菌性脑膜炎俄勒冈州儿童健康）.pdf

Pediatr Clin N Am 52 (2005) 795– 810 Bacterial Meningitis in Children * Susana Cha´vez-Bueno, MD , George H. McCracken, Jr, MD Department of Pediatrics, Division of Pediatric Infectious Diseases, University of Texas Southwestern Medical Center of Dallas, 5323 Harry Hines Boulevard, Dallas, TX 75390-9063, USA Meningitis is defined as inflammation of the membranes that surround the brain and spinal cord. Microbiologic causes include bacteria, viruses, fungi, and parasites. Before routine use of pneumococcal conjugate vaccine, bacterial men- ingitis affected almost 6000 people every year in the United States; about half of all cases occurred in children 18 years old or younger [1]. Approximately 10% of patients with bacterial meningitis die [2], and 40% have sequelae including hearing impairment and other neurologic sequelae [3]. Epidemiology The etiology of bacterial meningitis is affected most by the age of the patient. In neonates, the most common etiologic agents are group B streptococci (GBS) and gram-negative enteric bacilli. Although the incidence of early-onset neonatal GBS disease decreased by two thirds after implementation of the Centers for Disease Control and Prevention revised guidelines for intrapartum antibiotic prophylaxis in 2002 [4,5], GBS remains an important cause of late-onset disease, typically manifest as meningitis. Escherichia coli and other gram-negative enteric bacilli, including Klebsiella, Enterobacter, and Salmonella, cause sporadic dis- ease except in nosocomial outbreaks and in developing countries [6–8]. Other pathogens that occasionally cause meningitis in neonates, especially during out- breaks, include Listeria monocytogenes, Enterobacter sakazakii [9,10],