细菌性脑膜炎266例病原学与耐药性分析

Etiology and Antimicrobial Susceptiblity of Children with Bacterial Meningitis

目的 回顾性调查2000-2005年临床诊断符合细菌性脑膜炎（BM）患儿266例的脑脊液致病菌及耐药性情况。方法致病菌采用常规方法分离培养，细菌鉴定采用革兰染色、API生化鉴定系统（法国生物梅里埃），X、V因子试验（嗜血杆菌属）、Optochin试验（肺炎链球菌阳性）及肺炎链球菌、B型流感嗜血杆菌及脑膜炎奈瑟菌抗原检测（乳胶凝集方法）。细菌抗生素耐药检测采用KB及E-test法。结果乳胶凝集法显示BM患儿主要病原菌为肺炎链球菌（20．0％，）、B型流感嗜血杆菌（15．4％）、脑膜炎奈瑟菌（7．7％）。培养法提示凝固酶阴性葡萄球菌引起BM比例为15．4％，大肠埃希菌为4．9％。88．9％凝固酶阴性葡萄球菌对苯唑青霉素耐药（MRS）。结论肺炎链球菌、B型流感嗜血杆菌及脑膜炎奈瑟菌仍是上海地区BM儿童的主要病原菌，葡萄球菌引起BM所占比例超过脑膜炎奈瑟菌且多为苯唑西林耐药株。我国BM儿童病原菌谱存在一定地域差异。

Objective To review the etiology, antimicrobial susceptiblity in children with bacterial meningitis at children＇s hospital ot fudan university from 2000 to 2005. Methods The bacteria from cerebrospinal fluid （CSF） was evaluated by Grain stain, API system, X orV factor test, Optochin test. The antigen detection （latex agglutination test, LAT） was done for neisseria meningitidis, streptococcus pneumoniae and B haemophilus influenzae. The antimicrobial susceptibility was detected by KB and E-test. Results The predominant bacteria tested by LAT were streptococcus pneumoniae （20.0%）, B haernophilus influenzae （ 15.4% ）, and neisseria meningitis （7.7 % ）. The predominant bacteria isolated from culture were staphylococcus epidermidis（ 15.4 % ）, and 88.9 % of them were methicillinresistant staphylococcic（MRS）. Conclusions The predominant bacteria in children with meningitis are streptococcus pneumoniae, B haernophilus influenzae and neisseria meningitidis. The isolating rate of strphylococcus is higher in recent years and most of them are MRS. The etiology of BM varies in different areas of China.