title: Escherichia Coli Meningitis Features in 325 Children From 2001 to 2013 in France.
abstract: BACKGROUND
  We aimed to describe features of Escherichia coli meningitis in a large population of children and the molecular characteristics of the involved strains to determine factors associated with severe disease or death.
  
  
  METHODS
  Between 2001 and 2013, a prospective national survey collected data for 325 children hospitalized with E. coli meningitis. The national reference center genetically characterized 141 isolates.
  
  
  RESULTS
  Among the 325 cases, 65.2% were term, 22.4% late preterm, and 12.5% very/extremely preterm infants. Escherichia coli meningitis was 7-fold more frequent in preterm than term infants. Median age at diagnosis was 14 days; 71.1% of infants were neonates, with 2 peaks of infection at age 0-3 days (mostly preterm neonates) and 11-15 days (mostly term neonates); 8.9% were >89 days old. In total, 51.1% patients were considered to have severe disease, and 9.2% died. B2.1 phylogenetic subgroup (56%) and O1 serogroup (27.7%) were the most frequently identified. On multivariate analysis, death was associated with preterm birth (odds ratio [OR], 3.3 [95% confidence interval {CI}, 1.3-8.4], P = .015 for late preterm infants; OR, 7.3 [95% CI, 2.7-20.9], P < .001 for very/extremely preterm infants) and cerebrospinal fluid (CSF) to blood glucose ratio <0.10 (OR, 15.3 [95% CI, 1.8-128.3], P = .012). Death was associated with uncommon O serogroup strains (P = .014) and severe disease with O7 serogroup (P = .034) and PapGII adhesin (OR, 2.3 [95% CI, 1.2-4.5], P = .015).
  
  
  CONCLUSIONS
  In this large study of 325 cases of E. coli meningitis, risk factors of severe disease or death were preterm birth, severe hypoglycorrhachia, CSF/blood glucose ratio <0.10, and molecular characteristics of strains, which should help optimize therapeutic management.
authors.affiliation: Infection, Antimicrobials, Modelling, Evolution (IAME), Unité Mixte de Recherche (UMR) 1137, Institut National de la Santé Et de la Recherche Médicale IAME, UMR 1137, Université Paris Diderot, Sorbonne Paris Cité Assistance Publique - Hôpitaux de Paris (AP-HP), Laboratoire de Microbiologie, Centre National de Référence associé Escherichia coli AP-HP, Service de Pédiatrie Générale.
authors.forename: Romain
authors.initials: R
authors.lastname: Basmaci
authors.affiliation: Infection, Antimicrobials, Modelling, Evolution (IAME), Unité Mixte de Recherche (UMR) 1137, Institut National de la Santé Et de la Recherche Médicale IAME, UMR 1137, Université Paris Diderot, Sorbonne Paris Cité Assistance Publique - Hôpitaux de Paris (AP-HP), Laboratoire de Microbiologie, Centre National de Référence associé Escherichia coli.
authors.forename: Stéphane
authors.initials: S
authors.lastname: Bonacorsi
authors.affiliation: Infection, Antimicrobials, Modelling, Evolution (IAME), Unité Mixte de Recherche (UMR) 1137, Institut National de la Santé Et de la Recherche Médicale IAME, UMR 1137, Université Paris Diderot, Sorbonne Paris Cité Assistance Publique - Hôpitaux de Paris (AP-HP), Laboratoire de Microbiologie, Centre National de Référence associé Escherichia coli.
authors.forename: Philippe
authors.initials: P
authors.lastname: Bidet
authors.affiliation: AP-HP, Service de Réanimation et Pédiatrie Néonatales, Hôpital Robert-Debré, Paris.
authors.forename: Valérie
authors.initials: V
authors.lastname: Biran
authors.affiliation: AP-HP, Service de Réanimation et Pédiatrie Néonatales, Hôpital Robert-Debré, Paris.
authors.forename: Yannick
authors.initials: Y
authors.lastname: Aujard
authors.affiliation: Assistance Publique - Hôpitaux de Paris (AP-HP), Laboratoire de Microbiologie, Centre National de Référence associé Escherichia coli.
authors.forename: Edouard
authors.initials: E
authors.lastname: Bingen
authors.affiliation: Association Clinique Thérapeutique Infantile du Val de Marne, Saint Maur des Fossés.
authors.forename: Stéphane
authors.initials: S
authors.lastname: Béchet
authors.affiliation: Association Clinique Thérapeutique Infantile du Val de Marne, Saint Maur des Fossés Groupe de Pathologie Infectieuse Pédiatrique, Paris Unité Court Séjour, Petits Nourrisson, Service de Néonatologie Centre de Recherche Clinique, Centre Hospitalier Intercommunal de Créteil, France.
authors.forename: Robert
authors.initials: R
authors.lastname: Cohen
authors.affiliation: Association Clinique Thérapeutique Infantile du Val de Marne, Saint Maur des Fossés Groupe de Pathologie Infectieuse Pédiatrique, Paris Centre de Recherche Clinique, Centre Hospitalier Intercommunal de Créteil, France.
authors.forename: Corinne
authors.initials: C
authors.lastname: Levy
mesh_terms: D001786:Blood Glucose; D004926:Escherichia coli / Q000145:classification / Q000235:genetics; D005260:Female; D005602:France / Q000453:epidemiology; D005947:Glucose / Q000134:cerebrospinal fluid; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007232:Infant, Newborn, Diseases / Q000453:epidemiology* / Q000382:microbiology* / Q000401:mortality / Q000503:physiopathology; D008297:Male; D020814:Meningitis, Escherichia coli / Q000453:epidemiology* / Q000382:microbiology* / Q000401:mortality / Q000503:physiopathology; D011446:Prospective Studies; D012307:Risk Factors
chemical_list: D001786:Blood Glucose; D005947:Glucose
keywords: Escherichia coli; children; meningitis; neonatal infection