Clinical features, management, and prognosis of Bacillus cereus sepsis in premature neonates

Abstract

This study aimed to investigate the clinical characteristics, management and prognosis of Bacillus cereus sepsis in premature neonates. The clinical information of 8 premature neonates with B cereus sepsis who were treated in Shanghai Children Hospital from January 2015 to December 2019 was retrospectively collected from the medical records and analyzed. The neurodevelopment related conditions were collected at follow up visits at corrected age of 6 months and 12 months. Five patients developed meningitis, and cerebral magnetic resonance image showed abnormal in 5 patients. After treatment with meropenem and vancomycin, 1 patient died, and 7 patients survived and were smoothly discharged. At follow up visits, 1 patient was diagnosed with hydrocephalus and showed severely delayed neurodevelopment, 2 patients had mild delayed neurodevelopment, and the neurodevelopment was basically normal in remaining 4 patients. B cereus infection can cause severe complications of central nervous system, and affect neurodevelopmental outcome. Antibiotic treatment with meropenem and vancomycin is proven to be effective. Refreshing the central catheters is helpful for the prevention of B cereus sepsis and cerebral magnetic resonance image may be employed for the prognosis assessment.

Figure 1.

Cerebral MRI. (A and B) Hemorrhagic liquefactive necrosis of left hemisphere. (A) Abnormal hyperintensity at frontoparietal temporal lobes on both sides; T1WI sagittal view mixed low point hyperintensity, and hyperintensity on T2WI. (B) Reexamination after 2-wk treatment. Multiple patchy abnormal hyperintense foci at frontoparietal temporal lobes on both sides, with similar range to that in A; spotted hyperintensity on both T1WI and hypointensity on T2WI; while there was no significant change where T2WI had hyperintensity and T1WI had hypointensity (softening lesions). (C) T2-flair enhancement. Right temporal meningeal enhancement. Obvious enhancement (about 2.8 cm) was observed at the right temporal meninx. (D) Encephalocele and parietal lobe on both sides showed platy low T1 signal and high T2 signal, with ill-defined borders, partially connected to the rear corners of encephaloceles on both sides; encephaloceles on both sides were enlarged, while diocoel and epicotyl had no obvious enlargement. MRI = magnetic resonance image.