南宁市新生儿细菌性脑膜炎监测研究

SURVEILIANCE FOR NEONATAL BACTERIAL MENINGITIS IN NANNING CITY

目的 掌握本地区新生儿细菌性脑膜炎的流行病学和临床特征,提高该病的防治水平。方法 对南宁市2000年12月-2002年11月67,342名新生儿进行主动监测。疑似病例作脑脊液(CSF)常规检查和血、CSF细菌分离培养。脑膜炎患婴进行动态评估与定期随访。结果 临床细菌性脑膜炎47例,发病率69.8/10万,农村病例占76.6％;明显高于城区;≤7天新生儿占61.7％,其中2天内占34.0％;医源性感染占6.4％。临床表现不典型,CSF中WBC中位数(M)=46×106/L,蛋白中位数(M)=1.83 g/L,WBC数与蛋白定量之间具有高度相关性(r=0.5308 t=4.2015 P<0.001)。CSF培养出病原菌4例(8.5％),阳性率低可能与检测前使用抗生素病例较多有关。血培养阳性率29.8％,以大肠埃希菌和葡萄球菌为主。病死率25.5％,后遗症发生率48.6％。结诊降低该病发生率的关键,在于加强农村围产儿感染的防治和控制医源性感染。致病原流行病学监测,有利于临床诊治水平的提高。

Objectives To characterize the epidemiologic and clinical features of bacterial meningitis in neonates in Nanning City, in order to improve the prevention and control of this disease. Methods A population of 67,342 neonates in Nanning were under active suiveillance during December 2000 through November 2002. Cerebrospinal fluid (CSF) and blood specimens were obtained from suspected cases for routine tests and culturing. The patients with bacterial meningitis were evaluated dynamically and followed up periodically. Rcsults 47 cases with clini-cally- defined meningitis were identified, with an incidence of 69.8 per 100,000 population. Of those, nirai patients made up 76.6%, considerably more than those in the urban city. Neonates≤7 days accounted for 61.7%, neonates ≤2 days accounted for 34.0% and 6.4% of cases were due to iatrogenic infections. The patients pre-sented with atypical clinical manifestations. Median WBC counts in GSF= 46×106 cells/L; median CSF protein = 1.83 g/L. There was a high correlation (r = 0.5308, t =4.2015, P <0.001) between WBC and protein in CSF. 4 isolates were detected from CSF cultres. The low culture rate may have been ascribed to the antibiotic pre -treatment in most cases. Blood culture was positive in 29.8% of the total cases, E. coli and Staphylococcus species being the major agents. The case - fatality rate was 25.5% and 48.6% of surviving patients were left with sequela. Conclusion Intensifying the prevention of perinatai infections in rural areas and the control of iatrogenic infections are the key efforts in lowering the attack rates of bacterial meningitis. Epidemologic surveillance for eti ology can provide evidence for accurate diagnosis and appropriate treatment of patients.