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Updated: Jul 1, 2025
Constructing Mutants in Serotype 1 Streptococcus pneumoniae strain 519/43
Published on: September 11, 2020
[A multi-center epidemiological study on pneumococcal meningitis in children from 2019 to 2020]
Cai-Yun Wang1, Hong-Mei Xu, Gang Liu
1Department of Infectious Diseases, Children's Hospital of Zhejiang University School of Medicine, Hangzhou 310052, China (Chen Y-H, Email: cyh18@zju.edu. cn).
Insights
Pneumococcal meningitis (PM) in children under 3 years old presents with fever and complications like subdural effusion, especially in infants. Streptococcus pneumoniae remains sensitive to vancomycin, linezolid, and meropenem.
Area of Science:
- Pediatric Infectious Diseases
- Microbiology
- Clinical Neurology
Background:
- Pneumococcal meningitis (PM) remains a significant cause of childhood morbidity and mortality.
- Understanding the clinical spectrum and antimicrobial susceptibility patterns of Streptococcus pneumoniae (SP) is crucial for effective management.
Purpose of the Study:
- To investigate the clinical characteristics and prognosis of pediatric PM in China.
- To determine the drug sensitivity of SP isolates causing meningitis in children.
Main Methods:
- Retrospective analysis of 160 hospitalized children (<15 years) with PM from 2019-2020.
- Inclusion of clinical, laboratory, and microbiological data from 33 tertiary hospitals.
- Evaluation of SP isolation rates, detection methods, clinical manifestations, complications, and antimicrobial susceptibility.
Main Results:
- PM predominantly affected children aged 3 months to under 3 years (68.1%).
- Common symptoms included fever (91.9%), lethargy (61.3%), and vomiting (38.1%).
- Intracranial complications, particularly subdural effusion/empyema (26.9%) and hydrocephalus (15.0%), were more frequent in infants (<1 year).
- SP isolates showed high sensitivity to vancomycin, linezolid, and meropenem, but low sensitivity to penicillin and resistance to erythromycin.
- Non-culture methods improved pathogen detection rates.
Conclusions:
- Pediatric PM is most common in young children (3 months to <3 years), with infants (<1 year) at higher risk for intracranial complications.
- Fever is the primary symptom, and subdural effusion/empyema and hydrocephalus are the most frequent complications.
- Vancomycin, linezolid, and meropenem are effective treatments, while resistance to penicillin and erythromycin is a concern.
- Advanced detection methods enhance pathogen identification.
Objectives:
To investigate the clinical characteristics and prognosis of pneumococcal meningitis (PM), and drug sensitivity of Streptococcus pneumoniae (SP) isolates in Chinese children.
Methods:
A retrospective analysis was conducted on clinical information, laboratory data, and microbiological data of 160 hospitalized children under 15 years old with PM from January 2019 to December 2020 in 33 tertiary hospitals across the country.
Results:
Among the 160 children with PM, there were 103 males and 57 females. The age ranged from 15 days to 15 years, with 109 cases (68.1%) aged 3 months to under 3 years. SP strains were isolated from 95 cases (59.4%) in cerebrospinal fluid cultures and from 57 cases (35.6%) in blood cultures. The positive rates of SP detection by cerebrospinal fluid metagenomic next-generation sequencing and cerebrospinal fluid SP antigen testing were 40% (35/87) and 27% (21/78), respectively. Fifty-five cases (34.4%) had one or more risk factors for purulent meningitis, 113 cases (70.6%) had one or more extra-cranial infectious foci, and 18 cases (11.3%) had underlying diseases. The most common clinical symptoms were fever (147 cases, 91.9%), followed by lethargy (98 cases, 61.3%) and vomiting (61 cases, 38.1%). Sixty-nine cases (43.1%) experienced intracranial complications during hospitalization, with subdural effusion and/or empyema being the most common complication [43 cases (26.9%)], followed by hydrocephalus in 24 cases (15.0%), brain abscess in 23 cases (14.4%), and cerebral hemorrhage in 8 cases (5.0%). Subdural effusion and/or empyema and hydrocephalus mainly occurred in children under 1 year old, with rates of 91% (39/43) and 83% (20/24), respectively. SP strains exhibited complete sensitivity to vancomycin (100%, 75/75), linezolid (100%, 56/56), and meropenem (100%, 6/6). High sensitivity rates were also observed for levofloxacin (81%, 22/27), moxifloxacin (82%, 14/17), rifampicin (96%, 25/26), and chloramphenicol (91%, 21/23). However, low sensitivity rates were found for penicillin (16%, 11/68) and clindamycin (6%, 1/17), and SP strains were completely resistant to erythromycin (100%, 31/31). The rates of discharge with cure and improvement were 22.5% (36/160) and 66.2% (106/160), respectively, while 18 cases (11.3%) had adverse outcomes.
Conclusions:
Pediatric PM is more common in children aged 3 months to under 3 years. Intracranial complications are more frequently observed in children under 1 year old. Fever is the most common clinical manifestation of PM, and subdural effusion/emphysema and hydrocephalus are the most frequent complications. Non-culture detection methods for cerebrospinal fluid can improve pathogen detection rates. Adverse outcomes can be noted in more than 10% of PM cases. SP strains are high sensitivity to vancomycin, linezolid, meropenem, levofloxacin, moxifloxacin, rifampicin, and chloramphenicol.
